VARA Application for Membership
Date of Application__________
First Name __________________ Middle Initial ____ Last
Name_________________________
Date of Birth ____________ Your Spouse's Name_____________________________
Street or PO Address___________________________________________________
City_____________________________ State_____ Zip Code___________________
Home Phone __________________ Fax ______________________
Work Phone_______________________ Extension ________
Occupation______________________________________________________
YR ____ Make ____________________ Model _________ Displacement ________
YR ____ Make ____________________ Model _________ Displacement ________
YR ____ Make ____________________ Model _________ Displacement ________
YR ____ Make ____________________ Model _________ Displacement ________
(Check Here) ___Yes I am interested in working in the race organization
I am a member of the following Racing Clubs:
_____________________________
_____________________________
I am a member of the following Car Clubs:
1.___________________________________________________________
2.___________________________________________________________
3.___________________________________________________________
How did
you hear about VARA? Friend Magazine Other
Please Note: First year membership is $75.00
VARA annual renewal is $50.00 per year.
Please print application and mail checks to the following address:
VARA