2004 LVATV Membership Renewal

     _______ Individual $20 (18 and older) Member # ________
_______ Family $25 Member # ________
Includes annual $5 membership to the Pennsylvania Off-Highway Vehicle Association (PaOHV)
Name  ___________________________________________________
Address  _________________________________________________
City, State & Zip ___________________________________________ 
Telephone #  ______________________________________________
Email address  _____________________________________________
NOTE: All conditions and terms of your original membership still apply.
Return completed application and remittance to:
Lehigh Valley All-Terrain Vehicle Association
PO Box 179; Nazareth, PA 18109