WAI Membership Application Form  2007

Online registration is not available at this time, but this form can be printed out and mailed in to...

Dede Padberg
S85 W18525 Jean Dr
Muskego, WI 53150-9287

Club membership dues are

$30 per year for a single member

$35 per year for up to two members at same address

$40 per year for more than two members at same address

. Please make all checks made payable to WAI. The dues cover an individual or any number of family members at the same mailing address. Points will only be retroactive for one event when you join during the season.

Driver Information

Name:              Age: Sex: (M/F)

Address:

City: State: Zip:

Home Phone: Work Phone:

Fax: E-Mail:

Occupation: Employer:

Drivers License No: State: Exp. Date:

In case of emergency notify:

Phone:

BVR Member?

Car Information

Solo II Class Check if entry is Ladies Class

Car Number Preferred: 1st 2nd: 3rd:

Make: Model: Year: Color:

Tire Brand: Tire Size: Engine:

 

Additional Family members

Please fill out a separate form for these folks too

Name: Name:

Note about yourself, questions, etc.

 

Use one form per driver.

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