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