Southwest SuperChargers Membership Form

Team Name _______________________________

Owner Information                                                                Driver Information
Name __________________________________        Name _______________________________
Address ________________________________        Address _____________________________
City      _________________________________       City       _____________________________
State     ___________________ Zip __________       State     _________________ Zip _________
Phone  (_____)________-__________________        Phone  (_____)______-_________________
SSN#  __________________________________       SSN#   ______________________________
NHRA# ________________IHRA#__________        NHRA#______________IHRA#__________
EMAIL  ________________________________        EMAIL ______________________________

Signed:_________________________________        Signed:______________________________

Car Information:                                                           Crew Info:
Body Year and Style                                                       _____________________________________
________________________________________        _____________________________________
Engine make and Size:______________________      _____________________________________
_________________________________________      Sponsorship Info: _____________________
                                                                                           _____________________________________
                                                                                           _____________________________________
Please return with annual dues $200.00 Check money order or major credit card payable to:

Southwest SuperChargers
1211 Desert Dawn
Alamogordo, NM   88310

Received: _________________________________            Member#________________________________