| First Name: _____________________________________________________ |
| Last Name: _____________________________________________________ |
| Address: _______________________________________________________ |
| City, State, Zip:___________________________________________________ |
| Phone Number:(_________)________________________________________ |
| S/S Number:_________-_________-_________ Bike #:______________ |
|
Class of Competition: Please Circle
|
|
Funny Bike / Top Gas / Super Comp / Super Gas / Pro E.T. / Street E.T./ SBS
|
Annual Membership: $35.00 / Single
Race $10.00 |
