CAPS Membership Form

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CAPS MEMBERSHIP APPLICATION/ INFORMATION

 

Name:_________________________________________ Phone:___________________

 

Address:________________________________________________________________

 

City:__________________________________________ State:____________________

 

AMA#_____________________________ NMPRA#____________________________

 

Email Address:___________________________________________________________

 

DOB:______________ Your Club Name:______________________________________

 

City/State:_______________________________________________________________

 

ANNUAL DUES: OPEN MEMBERSHIP…………………………………………$25.00

 

Spouse or Friends Dues………………………………………………………………$5.00

Name:_____________________________________________ DOB:________________

 

Please complete the above information and return it with your money.

Make checks payable to: CAPS Pylon Racing

Send to:   Carolyn Martin

                2021 W. Dorothy Lane

                Dayton, OH   45439