PLEASE PRINT CLEARLY
Name: __________________________________________________________
Street: __________________________________________________________
City: _______________________ Prov:_____ Postal Code:______________
Home Phone: ______________________ Work Phone: _______________________
Fax: ______________________ Email: _____________________________
Vehicle Information:
Year: ____________ Make/Model : __________________________________________
Class (please check one): Bike/Sled___ Sportsman___ Pro___ Super Pro___
Membership Type (please check one): Active _____($20.00) or Associate ____($50.00)
Please check one: Renewal Membership______ or New Membership _____
If you have any Comments or Suggestions, please include them below (if extra space is required, please use the back of this form)
Please return the above completed form along with appropriate Membership Dues to:
For more information email us at atlanticdrag@hotmail.com TO PRINT THIS MEMBERSHIP FORM, CLICK "PRINT" IN YOUR BROWSER'S TOOLBAR If you would like to be part of our ADRA Scrapbook, please forward a picture of your vehicle along with this membership form.
