APPLICATION FOR
CAMPING PERMIT/
RENEWAL
MAD RIVER CLUB INC
FOUNDED 1894
DATE:
______________________________
PO BOX 171
PULASKI, NY 13142
MEMBERS NAME: ______________________
ADDRESS: _____________________________________
BADGE NUMBER_______
PHONE NUMBER:_________________________________ ___________ SITE NUMBER ______________
TYPE OF CAMP:
_________________________________________________________________
(TENT, TRUCK, CAMPER, ETC)
MEMBERS OF
CAMP SITE: _____________________________________________
REASON: ______ APPLICATION ______ RENEWAL
SIGNATURE: __________________________________ SIGNATURE:
________________________________
(CAMPING
CHAIRMAN)
(MEMBER)