United States Late Model Association by hVM8PF2

VIEWS: 8 PAGES: 1

									United States Late Model Association
USLMA office: 701 W. 4th Street Pueblo, CO 81003 (719)-543-0218 Fax: (719)-543-0221
                   Cell: (719)-251-1269 Website: www.uslma.com




              2009 Membership Form
                         Driver/Owner Fee -- $100

Make checks payable to:                Owner               Driver
                                             (Please circle one)

Name__________________________________________________________
Address________________________________________________________
City_____________________________State___________Zip_____________
Daytime Phone___________________ Night Phone____________________
E-Mail___________________________ Cell Phone_____________________
SSN#____________________________

NOTES:
  1. All drivers and owners who wish to participate in USLMA events in 2008 must be fully
     paid current members in good standing of the association.
  2. Only members of USLMA are allowed to vote on rules and regulations for USLMA.
  3. All members who wish to receive payments for their respective team must provide
     USLMA with a completed W-9 form before any checks are cut.
  4. USLMA reserves the right to refuse any membership application.

DRIVERS ONLY:
Drivers Name___________________________________________________
Year, Make & Model of Race Vehicle____________________________
Car Number_________1st Choice_________2nd Choice_________3rd Choice
Sponsors_______________________________________________________
_______________________________________________________________
Type of Chassis____________________ Engine Builder________________
Type of Oil________________________ Type of Fuel__________________
Type of Wheels____________________ Type of Shocks________________
Type of Springs____________________ Type of Trailer________________
Type of Body______________________ Type of Helmet________________
Type of Drivers Suit_________________ Type of Gloves_______________
Type of Gauges____________________ Type of Fuel Cell______________

								
To top