Purchase your 2011/2012
Directly from the Pontiac Snowmobile Drivers Association Inc.
P.O. 945, Shawville, Qué.
J0X 2Y0
To order Trail pass and/or make
a donation using VISA or MASTER CARD.
Mail a completed copy of this form or FAX it to (819) 455-9328. A Membership in
the PSDA entitles the holder to ride on all the 33,000 km of groomed trails in
the
____________________________________________________________________________
PSDA
Trail pass order form (Please write in block letters) For each trail pass
purchased the following information is needed:
Family Name: ___________________________ First
Name: ______________________
Address: ________________________ City: ___________________ Prov:
___________
Postal Code: ___________ Phone: Home: _______________ Office: ______________
Snowmobile:Make:______________________
Model: _________________ Year: _______
Serial Number: ____________________________ License Number:______________
Canadian Resident: Y __ N __
RENONCIATION STATEMENT
As a member of a snowmobile club, I, undersigned,
owner of the snowmobile described above, declare that I am liable for the use
of a trail in conformity with the snowmobile regulations as written in the text
available at the Fédération des Clubs
de Motoneigistes du Québec (F.C.M.Q.)
Inc. I declare that i am well aware of the
risks related to the presence of tree branches, stones and soil in the trail as
well as the risks related to the maintenance and signalization of a
trail. I hereby waive any rights of claiming any indemnity for damages be it of any kind, that could happen to me in the use of a
trail.
I also pledge, that I will inform any person to whom I would
lend or rent the snowmobile that I own of the risks aforementioned and will
advise them that the F.C.M.Q., the club or the owner of the trail do not assume
any responsability for the damages they could
undergo.
In witness whereof, I signed
Signature of member:
___________________________________________ Date:
__________________________________
Trail Pass price: (includes liability insurance
of $500,000)
Before December
9, 2011 $ 260.00 X __ $ _________ After December 9,
2011 $ 320.00 X __ $ _________
Donation: Trail, Relay building and equipment maintenance
$
_________
Total amount: -------------------------------------------------------------------->
$
_________
Paid: ___VISA
Number: _______________________________ Expiry Date: _____________
___MASTER
CARD Number: _______________________________ Expiry Date:
_____________
___CHEQUE (Payable to PSDA/AMP)
___Money Order (Payable to
PSDA/AMP)
Authorization for the credit
cards: ____________________________________
Signature
IMPORTANT: THIS SEASON, CANADIAN SNOWMOBILERS CAN
ASK FOR REIMBURSMENT OF LIABILITY INSURANCE ON A SEASON ANNUAL TRAIL
PASSES. THE INSTRUCTION WILL BE GIVEN TO YOU WITH THE
YOUR MEMBERSHIP CARD AND STICKER WILL BE FORWARDED TO YOU BY MAIL.