2018 SYRQMC Membership Application
**Full Club/Racing Associate/Alternate Handler Membership Application
Select One: *
Please provide a copy of birth certificates for all drivers.
Name: *
Your answer
Spouse: *
Your answer
Street Address: *
Your answer
City, State & Zip *
Your answer
Phone: *
Your answer
Email: *
Your answer
Current USAC25 Home Club: *
Your answer
Driver 1: *
Name:
Your answer
Male or Female *
Date of Birth *
MM
/
DD
/
YYYY
Rookie *
Classes Running *
Required
Driver 2:
Name:
Your answer
Male or Female
Date of Birth
MM
/
DD
/
YYYY
Rookie
Classes Running
Driver 3:
Name:
Your answer
Male or Female
Date of Birth
MM
/
DD
/
YYYY
Rookie
Classes Running
Alternate Handler 1:
Name:
Your answer
Email for Alternate Handler 1:
Your answer
Alternate Handler 2:
Name:
Your answer
Email for Alternate Handler 2:
Your answer
Alternate Handler 3:
Name:
Your answer
Email for Alternate Handler 3:
Your answer
Acknowledgement *
By signing this application, I/we hereby acknowledge membership to the Syracuse Quarter Midget Club for 2018. Membership will begin upon receipt of completed application with all necessary documents and fees, and is valid until December 31st of application year. Membership is subject to terms and conditions set forth in club rules and bylaws. Please provide the club with a copy of the driver's birth certificates. You can pay by paypal at PayPal.Me/SYRQMC
Your answer
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