KDRA Membership Form

Date_________________

Name_____________________Spouse________________________

Address, City, State, Zip _____________________________________

Phone ( )_____________ Cell ( )_____________ Alt( )_________

Dob___________________ Spouse Dob_______________________

Children’s Names & (Dob) Month & Day

_________________________________________________________

_________________________________________________________

Wedding Anniversary Date___________________________________

Race Car Info (Year, Make, Model, Engine, Class, Etc) ____________________

__________________________________________________________

Email Address:______________________________________________

To save the club money and time I.E stamps, copies, Etc. We are asking for
your email address for your newsletter so you can print it if you like or save
it in a folder of your own. If you prefer we can mail it to you.

Check Only One Please: Email: _____________ Mail: _______________

Would You Like To Be A KDRA Sponsor?_________________________

Are you A Junior Dragster Parent? _______________________________

If more than 1 member in this household, make a copy or add additional
sheet of paper please. To help the club keep track of all our members and
make sure everyone is recognized as they should be please mail this form
back to me at: 6106 Moorhaven Drive, Louisville, Ky 40219 if you would like to
add into the newsletter you can email me at: news@kdra.net
or call: 502-807-9244