Membership Form - Competitor

Owner Information:

Name _________________________

Address _______________________

City ___________________________

State _________ Zip______________

Phone (______ ) _______-_________

e-mail _________________________

web site _______________________

Driver Information:

Name ____________________________

Address __________________________

City _____________________________

State ___________ Zip ___________

Phone ( ) ____________________

License # _______________ Class ____

Car Information:

Body Year and Style:

_______________________________

Engine Make & Size:

_______________________________

(Include photo if available)

Performance (This car at a CIFCA event)

Best ET __________ Best MPH ________

Is Car Race Ready? Yes No

If no, anticipated completion date __________

Crew______________________________

___________________________________

Sponsors ___________________________

___________________________________

The team owner, driver and crew grant CIFCA the unrestricted right to acquire, reproduce and publish photographs, videos and printed matter of the car and team members. As a competitor, you are permitted to compete in CIFCA events and entitled to all benefits.

If you wish to PAY ONLINE - CLICK HERE

Billing Address

Phone Number

E-Mail Address:

Shirt Size

Card Type: Visa Mastercard

Card Number Exp.

** For your convenience CIFCA now accepts Visa & Mastercard **

Please return with annual dues $250. Make payable to CIFCA
If you wish to PAY ONLINE - CLICK HERE

8858 Painter Ave, Ste E * Whittier, CA * 90602 * 562/945-4159

Received ___________ File Updated ______________ Ack _____________