SSRTA Membership Application

SSRTA Membership Application

Please complete the form below. Membership runs January to December.
Please check one:
Full Name

First NameLast Name
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth
Membership Type
Is your ATV/UTV/Dual Sport registered?
Is your ATV/UTV/Dual Sport insured?
Year, Make and Model of Machine
Registration/DCNR License Plate #
Expiration Date
State
Insurance Co. Name
Policy #
Expiration Date
Attach a copy of proof of liability insurance and state’s registration.

Cancelof
Signature
Comments
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2026 SSRTA Membership
MEMBERSHIP YEAR RUNS JANUARY TO DECEMBER 2026

$30.00

Total

$0.00

Debit or Credit Card

Choose from one of the PayPal options to make your payment.