WSR 2006 Membership Form

                           Western Snowmobile Racing,   P.O. Box 60864 ;   Sunnyvale CA. 94088

CHECK ONE                              PRINT  CLEARLY

FULL MEMBERSHIP   $60   ____                ASSOCIATE MEMBERSHIP     $30 _____

FIRST NAME-_______________________ LAST NAME_______________________________________

ADDRESS_____________________________________________________________________________

CITY_______________________________________________STATE_____ZIP____________________

EMAIL________________________________________________________________________________

DAY PH#____________________________________EVENING #_______________________________

DOB______________________  SS#________________________(only if pro or semi-pro)

SLED BRAND______________________ YEAR_______________MODEL_______________________

RACE NUMBER __________________

SPONSORS____________________________________________________________________________

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