APPLICATION FOR MEMBERSHIP OR RENEWAL
Membership in this organization shall be open to all drivers, owners, fans, and other members of the racing fraternity as approved by the NYSSCA Board of Directors.
Please Print and Mail to the NYSSCA, Address is Below

Name__________________________________________________________________

Address ________________________________________________________________

City____________________________________State__________Zip_______________

Phone #________________________Car Owner (if other than driver)__________________

Division______________Car No._______Home Track(s)________________________

________________________________________________________________________

Driver_____Owner______Crew_____Sponsor_____Official_____Fan____Other_____

Membership application accepted only with payment of $25.00 fee.

16 & UNDER CONSENT OF PARENT OR GUARDIAN

New York State Stock Car Association

C/O Cheryl Catman

135 Columbia Tpke.

Rensselaer, NY 12144

All Memberships expire March 31st.