Driver

□ Midget

□ Midget Lite

$150.00

(After February 15, 2012 - $175.00)

Owner

□ Midget

□ Midget Lite

$138.00

(After February 15, 2012 - $163.00)

Owner/Driver Membership

□ Midget

□ Midget Lite

$150.00

(After February 15, 2012 - $175.00)

Vintage Midgets

□ Vintage Owner/Driver   $100.00

(After February 15, 2012 - $125.00)

Associate Memberships

□ Midget

□ Midget Lite

□ Vintage

$88.00

Name:

Email:

Address:

City:

State/Zip:

Home Phone: (        )

Work/Cell: (        )

Social Security #:

OK to release Phone Number? 
□ Yes   □ No