ESS Membership Form 2019/2020

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NEW AND RETURNING MEMBERS Please fill in the following form to become a member of Eastern States Speedway, whether financial or as a volunteer so we have current contact details for our records. One form per member please.

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電子郵件 *

Contact Details

Form Type *

New Member - Must have a nominator and seconder

Member Renewal - Nominator and seconder not required

必填

Membership Type *

Driver (Voting Rights) $100

Youth Ministocks (Voting Rights) $50

Pitcrew (Voting Rights) $50

Social Member (Voting Rights) $50

Volunteer (no charge, sponsored by Martin Motors)

Life Member $0

必填

Name *

Address *

Occupation (we may need your skills) *

Telephone

Mobile *

Preferred form of communication *

Phone

Text

必填

Drivers / Pitcrew

Please fill in the class and car number you are associated with

Racing Class

Youth Ministocks

Stockcars

Streetstocks

Productions

Saloons

Super Saloons

Modifieds

Sidecars

Car Number

Transponder Number

Drivers - Pitcrew names (if any)

New Member Nominations

This is for NEW members ONLY please - returning members do not require a nominator or seconder.
Both the nominator and seconder must be a financial member of Eastern States Speedway.

Nominated By

Seconded By

繼續

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