ERDBA Club Registration Form
2018
Email address *
Club Name *
Your answer
Website *
Your answer
Address (including City, State, Zip) *
Your answer
Club's ERDBA Representative - The ERDBA Representative is a person who is authorized to represent the club and vote on ERDBA matters. *
Your answer
Representative Phone *
Your answer
Representative Email *
Your answer
Secondary Contact Name - the Secondary Contact will only be authorized to vote if the primary representative is not available *
Your answer
Secondary Phone *
Your answer
Secondary Email *
Your answer
Club Teams: List your teams and their race divisions for the 2018 race season *
Your answer
Once above application is completed please date below and make check out to ERDBA for $300 ($330 if not postmarked by January 31, 2018) to Angela Acuna, Treasurer ERDBA, PO Box 771 Conshohocken, PA 19428 or pay via PayPal ($10 processing fee) at www.paypal.me/erdba/310 *
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A copy of your responses will be emailed to the address you provided.
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