I. Member License Application

I Am Applting For:

Member Name
 Date of Birth*
Social Security - - Email Address
Address City
State Zip Code
Home / Work - - Cell - -
Name that Checks Will Be Issued To
(This name will appear on your membership card and your 1099)
* The minimum age for NSPA competitors is 16. Special release forms are required for minors under the age of 18 years, the parents or legal guardians will have to sign a minor release waiver form for the 2008 season. A competitor must have a valid NSPA membership to compete in an nspa sanctioned event. Minor release forms are available from the NSPA office. For more information, call 719-329-8018.
 
  II. Membereship License Payment - 2008 Membership Fee is $150.00
Card


Expiration Date
Carholder Name Phone - -
Card Number - - - CVV Number - Three digit number located on back of card.
Signature - Checking represents my signature and I authorize NSPA to debit my account one time for the membership fee stated above.
   

 

© 2008 National Sled Pullers Association - Colorado