Offical  APPLICATION FOR MEMBERSHIP
    MID AMERICA OFF ROAD ASSOCIATION  www.maoraracing.us

Team Name______________________________________Number______________Class__________

Name: __________________________________________Phone:__________________________________
Address: _______________________________________________________Sex:_____Age:_____________
City: _____________________ST: ________________Zip code: __________Date of Birth: _______________

In Case of Emergency Notify: ________________________________________________________________
Phone:  ______________________________Relationship:_________________________________________
Signature: ___________________________________ Date:  ________/________/____________________

                                                          Driver Biography
Occupation: ___________________________________________________ Years Racing: _______________
Spouse/Companion: _______________________________________________________________________
How Many Children: __________________ Girls __________________________Boys_____________
Racing Goals:_____________________________________________________________________________
Hobbies:_________________________________________________________________________________
Comments:_______________________________________________________________________________
Email Address: ____________________________________________________________________________

                                                          Team Members

Name: ___________________________________ Duties: _________________________________________
Name: ___________________________________ Duties: _________________________________________
Name: ___________________________________ Duties: ________________________________________
Name: ___________________________________ Duties: ________________________________________

                                                                  Sponsors
Primary: ________________________________________________________________________________
Secondary: ______________________________________________________________________________
Others: _________________________________________________________________________________
DUES $85/ Year   $45/ One Day                       Make Checks Payable to: MAORA
                                                                 Mail to:      
MAORA                                                                                                                                                               422 E. Main St.
                                                                              DePauw IN, 47115    
                                                   
Recording Officer __________________________ Date _____/_____/_____

Approved? Yes or No
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