Toad Town Racing AHRMA Membership Application

AHRMA Membership Application

Please print this page, fill it in and mail with payment to:

AHRMA Membership Office
P.O. Box 882, Wausau
WI 54402-0882
Fax (credit card payment only): 715-842-9545. Information: 715-842-9699

___NEW MEMBERSHIP ___RENEWAL: AHRMA#__________
NAME__________________________________________________________________________
ADDRESS_______________________________________________________________________
CITY_______________________________________ STATE/PROVINCE____________________
ZIP (9 digits please)__________________-__________ COUNTRY____________________
PHONE - home______________________________ work_______________________________
DATE OF BIRTH______________________________ AMA#______________________________
OCCUPATION_____________________________________ # MOTORCYCLES OWNED:__________

Membership Types/Dues Rates

___ Competition member - $40. (Includes competition & voting privileges, newsletter, decals, membership card, rulebook
___ Sound of Singles roadracing license - $10 (Must be purchased in addition to racing membership
___ Battle of Twins roadracing license - $10 (Must be purchased in addition to racing membership
___ Canadian racing membership - $40
___ Overseas racing membership - $50
___ Nonracing member - $30 (Includes everything above, except racing privileges; U.S. residents only
___ Associate member - $10 (Nonracing member with another member in the same household;
no newsletter, handbook or voting privileges.)
___ Delivery of Vintage Views via first-class mail - add $10 (U.S. members only)

Competition Preferences
(check all that apply)

___ Roadrace - list one or more racing number choices: _________________________
Have you completed a roadracing school? ___Yes ___No **Please provide proof of your prior
roadracing experience (copy of race club membership card or roadracing school certificate)**
___ Motocross - list racing number choices. Vintage: _______________ Post-Vintage: _______________
MX skill level: ___Novice ___Intermediate ___Expert
___ Dirt Track - list one or more racing number choices: _______________________
___ Trials - skill level: ___Beginner ___Novice ___Intermediate ___Expert

Payment

___ Enclosed is a check or money order for $______________. ___ Please bill my MasterCard/Visa:
Credit card #_______________________________________________ Expires______________
Signature__________________________________________________ Date__________________
By applying for and accepting membership in AHRMA, I agree to abide by all rules of the AHRMA Handbook, as well as any event or track rules that may apply.

SPONSOR: GARY SWAN, AHRMA#861



Updated 22 April 2003