$40.00 Membership Fee
1) Entry in Point Series
2) 5 Free Pit Passes
MEMBERSHIP INFORMATION
Membership for Year of: __________
Committee Member: _________________________
What Committee: ____________________________
Personal Information
Name ________________________________________________________
Address: ______________________________________________________
City: ________________________ State: ________ Zip Code: __________
Phone #: ___________________ Email Address: _____________________
Vehicle Information
Vehicle Name: _________________________________________________
Make: _________________ Model: ________________ Year: __________
Engine: _____________________ Tire Size: _________________________
Carburetion: ________________ Suspension: _______________________
Nitrous: Yes ____ No ____ Fuel: _____________________________
Sponsors
1. ________________________________________________________
2. ________________________________________________________
3. ________________________________________________________
4. ________________________________________________________
5. ________________________________________________________
Members Name (Printed)__________________________________
Signature ______________________________________________
Date __________________________________________________
*************************************************************
IMRA Uses
Membership Dues paid to: _____________________________
Signature: __________________________________________
Date: ______________________________________________
Cash or Check: ______________________________________