V.D.T.R.A. Membership Form

Name:____________________________________________________________

Date of Birth:__________________________      Age:______________

Address:_____________________________________________________

_____________________________________________________________

Telephone:____________________________________________________

Email:_________________________________________________________

Race Number:___________  2nd Choice:__________     3rd Choice______________

New Member:______

Member Renewal:_______

 Professional License ($60)_______

Amateur License ($40)__________

Super Seniors’ License ($40)_________

 Support Memberships ($25)_________ (Non Racing Membership)

Week End Pass ($20)_______________

Memberships are good for one Calendar Year.

Calendar Year is from January to December of the current race season.

 Please make Checks Payable to : Vintage Dirt Track Racers Association.

 Mail Membership form and License Fee to:

VDTRA

3412 West Houston

Sherman Texas 75092

   **VDTRA Annual Release form must be submitted with VDTRA Membership form**