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)__________________

E-Mail:____________________________ Website:______________________________

Division______________Car No._______Home Track(s)________________________

________________________________________________________________________

Status: (Please check accordingly)

Driver_____Owner______Crew_____Sponsor_____Official_____Fan____Other_____

Membership application accepted only with payment of $25.00 fee.

Signature______________________________________________Date______________

16 & UNDER CONSENT OF PARENT OR GUARDIAN

SEND TO:

New York State Stock Car Association

C/O Cheryl Catman

10 Matthews Drive

Castleton, NY 12033

All Memberships expire March 31st.