Tma Form
DVSJ TMA Renewal
2011/2012
Resident ( ) Non-Resident Property Owner ( ) Non-Resident ( )
Name of Registered Owner
First Middle Initial Last
Mail Address
Number & Street City State Zip Code ______
Legal Address (if different)
Number & Street City State Zip Code ______
Telephone Number(s) E-Mail Address ______
Snowmobile Information
Year Manufacturer Model Serial # Registration # State
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________
TMA Fees
# of Regular Snowmobiles @ _____ each = __________
# of Family Snowmobiles @ ______each = __________
# of Classic Snowmobiles @______each = __________
Club Dues
Total Snowmobiles @ $20 each = ___________
Optional
Donation to help defray the cost of storm damage repairs: _________.
Total Enclosed________________________
LIMITED LIABILITY STATEMENT/Personal Liability Insurance
As a member of a snowmobile club I, the undersigned, owner of the snowmobile(s) described above, am liable for the use of a trail in conformance with the
snowmobile laws and rules of the state of Vermont. Without limiting the generality of the foregoing, I declare that I am well aware of the risks related to the
presence of tree branches, stones and soil on the trail as well as the risks related to the maintenance and signing of a trail. I also pledge that I will inform any
person to whom I would lend or rent the snowmobile that I own, of the risks mentioned above and will advise them that the association, the club or the owner of
the trail do not assume any responsibility for the damages they could undergo while using a trail.
As of September 1, 2003, every individual operating a snowmobile in Vermont is required to have personal liability insurance. The minimum
required coverage is $25,000 for one injury or $50,000 for two or more injuries or deaths with a minimum of $10,000 property damage. The fine for
operating without the insurance is $601.00 plus court cost.
All snowmobilers born after July 1, 1983 must have (and carry with them) a Vermont Snowmobile Safety Certificate or equivalent
_______________________ ____________________________________________________________________
Date Signed Signature
Forward TMA(s) in US Mail________________ Hold TMA(s) for Pick Up______________________