Office: (503) 626-0579 SHIRT SIZE:_____________

IF YOUR ADDRESS CHANGES DURING THE YEAR, PLEASE NOTIFY THE OFFICE. (PLEASE PRINT)

NAME: ________________________________________________ DATE: ________________________

ADDRESS: _____________________________________ CITY _________________________________

STATE_______ZIP_____________ SSN. #__________________ FAX #: (_____)_________________

EMAIL:_________________________________ EMERGENCY CONTACT #:(_____)_________________

HOME PHONE #: Area code (______)________________ IF HIGH SCHOOL NEED AGE:____________

WORK PHONE #: _________________ (OPTIONAL) CELL PHONE #: _________________ (OPTIONAL)

CLASS: ___________________________________ CAR #: ___________________________________

(SUPER PRO-PRO-SPORTSMAN-*MX-HIGH SCHOOL-Jr.DRAGSTER) (IF YOU HAVE AN NHRA #, PLEASE USE)

YEAR/MAKE/MODEL/COLOR OF CAR OR MX:

_____________________________________________________________________________________

(NEED THIS FOR PICTURES)

*NOTE: IF YOU ARE A MOTORCYCLE, YOU MUST COLLECT POINTS WITH MX AND NOT WITH CARS.

IN 2006 ALL MOTORCYCLES WILL RUN AGAINST MOTORCYCLES ONLY.

NHRA MEMBERSHIP #: ____________________________ EXPIRATION DATE: _________________

NHRA LICENSE (CAR) #:________________________ EXPIRATION DATE: ____________________

HIGH SCHOOL REPRESENTED (IF APPLICABLE) ____________________________

MAIL TO: 35 SW 131^st Ave. Beaverton, Or. 97005 ¤ E-Mail TO: pmaciaspir@yahoo.com