SMVR
2010 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, 2010
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 RESPONSIBITY FOR ANY DAMAGES OR INJURIES I MAY SUSTAIN AT ANY S.M.V.R. EVENT.
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Signature
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Print Name
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Driver's Profile
My Name: _________________________________________________ Car # _________________
I started driving in ______________________________________________________________________________________
A little about me ________________________________________________________________________________________
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