USARM Membership Application/Renewal P.O. Box 3682, Salinas, CA 93912

Name: ______________________________________ Birth Date: ______________

Address: ______________________________________________________________

City, State, Zip:______________________________________________________

Home Phone: ________________________ Country __________________________

Email:_________________________________________________________________

Work Phone: _________________________  Cell Phone: ____________________

Crew Experience: _____________________________________ # of Years _____

Occupation: _____________________________________ T-Shirt Size ________

Type of Application:New ____ Renewal ___ Address Change ___ Update ____
-----------------------------------------------------------------------
Emergency Medical Information

Medication Used: ______________________________________________________

Allergies : ______________________________________ Blood Type: ________
Emergency Notification

Name : _________________________________ Relationship: ________________

Address : _____________________________________________________________

Phone : _______________________________________________________________
-----------------------------------------------------------------------
USARM dues are $35.00 a year. All 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.

Signature : _________________________________________ Date : __________
-----------------------------------------------------------------------
For USARM Use:

Date Received _____/_____/_____    Date Processed: ____/____/____

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

Payment Type: Cash _______ Check # _______ Other: ________