USARMŽ Membership Application/Renewal P.O. Box 127 Gilroy, CA 95021

Name: ________________________________________ T-Shirt Size __________

Address: _____________________________________________________________

City _____________________________ State/Province ____________________

Postal Code _________________________ Country ________________________

Phone: _______________________ Alternate Phone: ______________________

Email: ________________________________ Occupation: __________________

Crew Experience: ____________________________________ # of Years _____
Specialties: Flag ____ Comm/Radio ____ Handler/Response ____ Grid ____
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Emergency Medical Information
Birth Date: ____________________________ Blood Type : ________________

Medication Used: _____________________________________________________

Allergies : __________________________________________________________
Emergency Notification

Name : __________________________________ Relationship: ______________

Address : ____________________________________________________________

Phone: _______________________ Alternate Phone: ______________________
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USARM dues are $25 and cover the calendar year, January 1-December 31.
All new memberships received after October 31 will apply to the 
following year. Membership must be paid for in advance before any events
are worked. Membership is to be paid to USARM and will NOT be taken out
of any reimbursement a member receives for a weekend. All membership 
renewals/new memberships MUST submit a completed application with their
current information (no matter how long you've been at your current 
address). Make your check/money order payable to USARM and mail to the 
address listed above.
I hereby apply for membership in the United States Auto Race Marshalls,
and agree to abide by its bylaws. You must be 18 to work on a 
corner/station at any event.
Type of Application: New ___ Renewal ___ Address Change ___ Update ___

Signature : ______________________________________ Date : ____________
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For USARM Use:
Date Received _____/_____/_____    Date Processed: ____/____/____

Membership Number: _______ Member Type: ________ Card Sent? Y___ N ___

Payment Type: Cash _______ Check # _______ Other: ________
Revision Date - 1/23/2012