First Name: _____________________________________________________

Last Name: _____________________________________________________

Address: _______________________________________________________

City, State, Zip:___________________________________________________

Phone Number: (_________)________________________________________
Email Address: __________________________________________________________

Bike#: ______________ (you can request any number as long as another racer is not using it)

Class of Competition: Please Circle

Pro Open / Top Gas / Super Comp / Super Gas / Super Street 9.50 / Pro E.T. / Street E.T. 

Annual Membership: $50.00 / Single Race $15.00

COMPLETE AND MAIL TO:

PMRA
1880 N. Winningkoff Rd
Lucas, TX 75002
CHECK OR MONEY ORDER payable to PMRA

DO NOT SEND CASH BY MAIL