ECTRA MEMBERSHIP APPLICATION
(Membership good thru December 31 of calendar year) 

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Email *
Full Name *
Address *
City *
State *
Zip Code *
Preferred Contact Phone Number *
Type of Membership *
Rookie Rider? If so, list member name
Are You an Existing Member? or New 
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ECTRA Member #
Family members: Please List ECTRA#, Family Member Name/Junior Date of Birth
If name has changed since prior membership please note it here
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