Date __________________

Name of Organization ______________________________________________________

Name of Contact Person _____________________________________________________

Title of Contact Person ______________________________________________________

Street Address _____________________________________________________________

City/ Town/ Village _________________________________________________________

State _______________________________ Zip __________________________________

Phone Number ______________________________________

Fax Number ________________________________________

E-mail ______________________________________________

Website _____________________________________________

Annual Dues:

Trail Group _____________________________________$ 25.00

Individual or family ______________________________ $ 25.00

Trail Users Group ________________________________$100.00

Municipality _____________________________________$100.00

Public or Private Agency __________________________ $100.00

Corporation or Business __________________________ $200.00

Make check payable to Genesee Region Trails Coalition.

Mail check and application to:

GENESEE REGION TRAILS COALITION
PO BOX 231
MENDON NY 14506