SLPS 2010 MEMBERSHIP FORM 

By submitting this form, you are requesting membership in the Super Lite Pro Series.  You have read all the rules and regulations and agree to abide by such said rules and regulations.  Violations of said rules and regulations are grounds for suspension from the Superlite Pro Series.


Drivers must also complete a Competitor License request with this form and return to Board of Directors

PLEASE PRINT

APPLYING FOR MEMBERSHIP AS A CREW MEMBER:______________  COMPETITOR:_____________

NAME:__________________________________________ AGE:_______________________ ADDRESS:__________________________________________________________________ CITY:________________________ STATE:______________________ZIP:________________
PHONE HOME:_______________ OFFICE:________________ CELL:___________________
 E-MAIL ADDRESS:____________________________________________________________


********************************************COMPETITOR USE ONLY*********************************************
 
 
ARE YOU THE DRIVER OF THE CAR?    YES        NO
TYPE OF CAR:______________________________________ COLOR:__________________
 CAR NUMBER DESIRED:_______________ SECOND CHOICE:_______________________
DRIVER’S LICENSE VERIFIED BY:__________________________________, Board of Directors 


IN CASE OF EMERGENCY, PLEASE LIST THE NAME, RELATIONSHIP AND PHONE NUMBERS OF ANY PERSON YOU WISH TO HAVE NOTIFIED:
NAME:__________________________ RELATION:_________________________________
PHONE:_________________________ CELL:______________________________________


 IN CASE OF HOSPITAL TRANSPORT VIA AMBULANCE, LIST HOSPITAL OF CHOICE: _____________________________________________________________________________


SIGNATURE:________________________________ DATE:__________________________


OFFICE USE ONLY:
 MEMBERSHIP APPROVED_______________________ MEMBERSHIP DECLINED:___________________ DATE:________________