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2012 MEMBERSHIP APPLICATION
Name___________________________________________Date____________
Spouse Name ____________________________________________________
Street___________________________________________________________
City________________________________State__________ZIP____________
Phone______________________________Cell_________________________
E-Mail __________________________________________________________
Car Year___________Make________________Model_____________________
Car Number__________Color of Car___________Engine__________________
My car is: Restored___________Replica____________Newly Built___________
S.M.V.R. dues are $30.00 for one year. Paid member will be able to race at all S.M.V.R. sponsored events, attend and vote at meetings and receive all club newsletters. Due by April 1, 2012 Make checks payable to: SMVR Mail to:Mike McDowell 12633 166th St., Linwood, KS 66052 I, THE UNDERSIGNED, HEREBY RELEASE AND HOLD HARMLESS THE OFFICERS AND
MEMBERSHIP OF S.M.V.R. OF ANY AND ALL RESPONSIBILITY FOR ANY DAMAGES OR
INJURIES I MAY SUSTAIN AT ANY S.M.V.R. EVENT.
_____________________________________________
Signature
_____________________________________________ Print Name
Driver's Profile My Name: _________________________________________________ Car # _________________ I started driving in ______________________________________________________________________________________ A little about me ________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ | |
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