BLUE MOUNTAIN ANTIQUE GAS & STEAM ENGINE ASSOCIATION MEMBERSHIP FORM
RENEWAL______ NEW______
PLEASE PRINT:
NAME: _____________________________________________________________________________________________________
ADDRESS: __________________________________________________________________________________________________
CITY: ___________________ STATE:______ZIP CODE:__________
TELEPHONE: _______________________________________________________________________________________________
MOBILE: ___________________________________________________________________________________________________
E-MAIL ADDRESS:___________________________________________________________________________________________
SIGNATURE: ________________________________________________________________________________________________
DATE: _______________________________________________________________________________________________________
FORMS MAY BE SUBMITTED BY DROPPING THEM OFF AT THE REGISTRATION BOOTH DURING ONE OF OUR SHOWS OR MAIL TO:
TOM BUIST
C/O BMAGSEA
2260 LAKE MINSI DRIVE BANGOR, PA 18013
*DUES ARE $10.00 ANNUALLY
*FAMILY MEMBERSHIP IS SAME PRICE AS INDIVIDUAL *MAKE CHECKS PAYABLE TO: BMAGSEA