Name *

First Name

Last Name

Spouse

First Name

Last Name

Sponsor *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Phone Spouse

(###)

###

####

DOB *

MM

DD

YYYY

DOB Spouse

MM

DD

YYYY

Areas of Interest

Please indicate committees you and or any member of your family are interested in.

Racing

Race Committee

Cruising

Membership

Trophies

Social Activities

Bar Operations

Club Maintenance

Publicity

Telephone Committee

Technical

Membership Fee *

The membership fee total does not include a one time $75 fee for club facilities. No Payment will be processed at this time.

Semi-Annual - $333 Due Jan & June

Annual - $635

Junior Membership (24 and under) - $317