BLACKBIRD MICRO MIDGET RACING CLUB, INC.

MEMBERSHIP APPLICATION 

P.O. Box 10246

Wilmington, DE 19850

Please send to: Barbara Sparks, BMMRC Secretary - 65 Clancy Rd. Salem, NJ 08079

Date:


 Individual member: $50    Driver: $60   Car Registration: $10    WDF: $200   Pit Spot $ 

All dues and fees are annual and are payable January 1. Any membership renewal or fee not paid by April 15th will be charged an additional $5.00 late fee.

LAST NAME  

FIRST NAME 

ADDRESS  

CITY  

STATE  

ZIP  

PHONE  

SOC SEC NUMBER ** 

 ** MUST BE FILLED IN IF YOU ARE CAR OWNER

CLASS 

  

CAR #

                               TRANSPONDER #

DATE OF BIRTH

BMMRC DRIVER ID **              D-

** ID IS CLUB DRIVER NUMBER ASSIGNED

OCCUPATION AND SKILLS

E-MAIL:  

MINIMUM DRIVER AGE: See Rulebook
NEW MEMBERS: under age 18 must present proof of age (Birth Certificate/Drivers License) with application

BMMRC MEMBERSHIP AGREEMENT

Upon being granted membership in the Blackbird Micro Midget Racing Club, Inc., I do hereby agree to abide by all By-Laws, Rules, Regulations, and such decisions of the Officials and Board of Directors that may affect my conduct  and activity, both on and off the track , as a member of the organization.

    ______________________________________________                     ___________________

                                     Signature                                                                    Date

DRIVERS ONLY:

I do hereby certify that                 I am         I am not
currently under any medical treatment which may impair my ability to compete as a driver in regular Micro-Sprint competition events
  __________________________________________                                                       _______________________ 
                     Signature                                                                                                    Date