APPLICATION FOR MEMERSHIP / RENEWAL

MEMBERSHIPS RUN FROM 1ST July 2011 to 30th June 2012

TYPE OF MEMBERSHIP (please tick)

SINGLE                        o $30

COUPLE                     o $45

FAMILY                        o $50

NAME (Member 1)______________________________________________________________

NAME (Member 2) ______________________________________________________________

CHILDRENS NAMES _________________________ __________________________________

POSTAL ADDRESS _____________________________________________________________

_____________________________________________________________________________

__________________________________________________________POSTCODE__________

TELEPHONE NUMBER (     )   ______________________

MOBILE                                        _______________________

EMAIL**_______________________________________________________________________

TYPE OF VEHICLE/BIKE __________________________________________________________

CLASS ___________ RACE NO.____________ BEST E.T. __________ BEST MPH ____________

*Please indicate if you wish to enter the Reaction Time competition and include $10 per entry.

Closest legal (green light) reaction time in eliminations to .400 wins the prize pool.

**Our preferred method of newsletter distribution is email. Please inform us if this is not convenient.

Please keep the club informed if any of your contact details change.

Post to: TDRA, PO Box 951, Kings Meadows, Tasmania, 7249.