South Louisiana Trailblazers Riding Club Inc.

www.SLTrailblazers.org

Online Credit Card Application

Read Notice:

All new members and re-new application can be process online.  No paper work to print out, no stamp or envelope to mail. Saving you time and money. If you don't want to pay for your membership with a credit card you can mail in your application. You will need Acrobat Reader to print out and mail your application.

If you need the free software Acrobat Reader, click Get Adobe Reader

Online Membership

This online membership has two parts.                                                                PAGE 1 OF 2
1. Complete the online application. Once completed, press the [Register Me] button at the bottom of the page. 
Once you complete this application, this application will be Electronically to be process.
2. Once completed, the application, you will be transferred to our credit card processing to confirm your membership.
If you don't complete both steps, you application can not be process. If you don't want to use your credit card and send us a check, please click here.

                          

Name:  Date of Birth (MM/DD/YY):  
 

Address: City, State:  

Zip Code:  

Home Telephone Number:  Cell or Work Number:  

Enter e-mail address:  ATV or Dirt Bike Type:  

You want your newsletter sent to you how? (E-Mail or Snail Mail :   

Types of membership: 

Family & Individual membership $ 20.00 Per Calendar Jan-Dec Year

Corporate membership $ 55.00 Per Calendar Year Jan- Dec - $55.00 Silver (details)

Corporate membership $ 150.00 Per Calendar Year Jan- Dec - $150.00 Gold (details)

Corporate membership $ 200.00 Per Calendar Year Jan- Dec - $200.00 Platinum (details)

Waiver Please Read Carefully Before Signing!

I undersigned apply for membership in the South Louisiana Trailblazers Inc. and do hereby agree to abide by all of the club rules and by-laws. I also acknowledge the risk to myself and family and property while participating in club events. I will rely on my own judgment and ability while participating in all club events and assume all risk of injury or damage arising out of such participation. I fully understand the sport of ATV and dirt bike riding can be dangerous and involves the risk of injury or death. I do understand that wearing protective gear will reduce my risk. I will not sue or make claim whatsoever against the South Louisiana Trailblazers Inc., Its members or to any organizers of club events as a result of such participation.

Signature: (Please type your full name is this space)
 (If under 18 parent or Guardian must sign)

Referred by: (Please type in the name)
  

  

This web page is  encrypting  your confidential information  using the Secure Sockets Layer protocol (SSL) with an encryption key length of 128-bits (the highest level commercially available) as you type it. Once you press the [register me] button it will send this information to process it.

Trailblazers Webmaster.
Copyright © 2005 South Louisiana Trailblazers, Inc. All rights reserved.
Revised: December 28, 2005 .