Hide Notes 

Slide 1: Medicine Hat Drag Racing Association 306 97 Carry Drive SE Medicine Hat, AB T1B 3M6 www.mhdra.com 1 (403) 548-7061 MEMBERSHIP FORM Please Fill Out Completely – Sign – Include Payment (cheque preferred) – Mail PERSONAL INFORMATION Last Name: ___________________________ First Name: ______________________________ Address: ________________________________________________________________________ City: ___________________________ Province: ____________________ Home Phone: _________________ _________________ Work Phone: ________________ Postal Code: ____________ Cell Phone: E-mail Address: _______________________ Date of Birth: _____________________ RACING INFORMATION Vehicle Year: _________ Make: ________________ Model: _________________ Competition Class you are signing up for: POINTS ACCUMULATE FROM DATE SIGNED MEMBERSHIP IS PAID IN FULL □ SUPERPRO $125 by 12/31/09 $150 after □ PRO $125 by 12/31/09 $150 after □ SPORTSMAN $50 by 12/31/09 $75 after □ BIKE $125.00 by 12/31/09 $150 after □ JR. DRAGSTER $25 by 12/31/09 $35 after □ ASSOCIATE $25 by 12/31/09 $35 after PIT SPACE RENTAL Please note: There are no new pit spaces available for 2010. Those renewing their rental from 2009 must have payment for their site in by December 31, 2009. For those who would like a reserved pit please check the ‘Waiting List’ box. □ □ □ Pit Site $125 by 12/31/09 $150 after Bike Site $80 by 12/31/09 $100 after Waiting List You Must Be A Paid Member To Be Eligible For A Pit Space Total Fees Owing For Class and Pit Rental: $__________ The Medicine Hat Drag Racing Association is a non-profit organization whose facility is member, volunteer, and sponsor built, maintained and managed. As a member of the MHDRA, I agree to actively participate in fund raising, maintenance, housekeeping, marketing, and promoting our sport, club, and facility. I will act responsibly and in the best interest of the sport and facility, and will adhere to the rules of good sportsmanship and mature conduct at all times. Signature: __________________ Parent/Guardian: ________________ Date: _______ (Under 18 requires signature of parent or legal guardian)
Slide 2: 2 OFFICE USE ONLY: Member# Received________ ____________ Paid Via: ___________ Date The MHDRA is a non-profit organization whose facility is member, sponsor, and volunteer built, maintained, and managed. We encourage drivers to race the strip, not the street, in an effort to keep our community roadways safe, while providing the racers with the opportunity to test and compete in a safe and strictly regulated manner. 2