MIDWEST DRAG RACERS ASSOCIATION - 2024 MEMBERSHIP FORM

NAME (LAST, FIRST, MI) _______________________________________________________________

ADDRESS:____________________________________________________________________________

__________________________________________________________________________________

(CITY) (STATE) (ZIP+FOUR)

SPOUSE/PARTNER/PARENT/GUARDIAN:_________________________________________________

PHONE NUMBER (PLUS AREA CODE):_______________________________________________________

(HOME) (WORK) (CELL)

E-MAIL ADDRESS:________________________________

MEMBERSHIP STATUS: NEW RENEWAL BIRTHDAY:__________________

PROFESSION/OCCUPATION:____________________________________________________________

AWARDS (ANYTHING NOTABLE):___________________________________________________________

VEHICLE YEAR & MAKE:________________________________ VEHICLE MODEL:_________________

VEHICLE NAME:_________________________________________

PERMANENT NUMBER:___________

NHRA/IHRA CLASS:________________________________________________________________________

ENGINE MAKE:________________________ CUBIC IN.:_______________ H.P.:_____________________

BEST ET:_______________________________________________________ BEST MPH:_______________

2024 MEMBERSHIP FEES: Please circle

$55 Competitor: Bracket I $55 Competitor: Bracket II $35 TrophyClass

(0 to 11.99 – Gizmo OK) (7.5 and up – No Gizmo)

$30 General Membership

$55 Competitor: Sportsman $30 Jr. Dragster Newsletter & Voting Privilage

(S/C, S/G, SST, STK, SS, SB) No Discounts for General Members

$5 DISCOUNT

IF YOU JOIN BEFORE First Race at BIR May 11th 2024

I agree to abide by the Bylaws & Operating Guidelines of the MIDWEST DRAG RACERS ASSOCIATION. I release MIDWEST DRAG RACERS ASSOCIATION from any liability resulting from accident or injury incurred while participating in or attending any Association racing or social event

This Document Must Be Signed

Signed___________________________ Parent/Guardian ___________________________Date __________

(If under 18 years of age, must be signed by Parent/Guardian)

RETURNED COMPLETED FORM WITH YOUR CHECK TO:

MDRA

P.O. Box 390

Zimmerman, MN 55398-0390

MDRA DECALS MUST BE VISIBLE FROM BOTH SIDES OF VEHICLE ALL SEASON

Memberships run from January 1st through December 31st

Help grow our membership! Sign up a member who was not an active MDRA member in 2023 and get a chance for cash

at the Spring Meeting. Write who referred you:_______________________