Membership Application 2010

CRACKERBOX RACING CLUB Membership Application 2010 Name ___________________________________________Date __________ Address _______________________________City _____________________ State___ Zip Code___________ (Check which phone numbers you want listed in the Club Directory :)

□Home Phone Number _________________□Cell Phone ________________ □Work Phone Number ___________________ Email ____________________ How would you like to receive information? By mail _____ By email _____

Please check any box(s) that apply:

□ Owner

Boat Name and

#______________________________

□Driver □Rider □Crew Member □Other

Boat Name and #______________________________ Boat Name and # _____________________________ Boat Name and #______________________________ Please Specify _______________________________

Membership Dues: $20.00 per year (January-December) Checks made payable to the Crackerbox Club Mail application with check to: Jeannie Doidge 10115 Gaviota Avenue North Hills, CA 91343 For Official Use Only: Date Received ___________ Amount Received ____________ Check # _______ CASH ____