Ellis River Riders ~ Membership Form
Mail to: Ellis River Riders, Inc
Jeff Bryant, 33 Mercier Lane, Livermore Falls, ME 04254

Name:_____________________________________

Address: ___________________________________

Town: ________________ State: _____ Zip: ______

Telephone: _________________________________

e-mail : ____________________________________

Single $20.00 _____         Family $25.00 _____

List family members: _________________________

__________________________________________