Offical APPLICATION FOR MEMBERSHIP
MID AMERICA OFF ROAD ASSOCIATION www.maoraracing.us
Email ____________________________________________________________
Team Name______________________________________Number______________Class__________
Name: __________________________________________Phone:__________________________________
Address: _______________________________________________________Sex:_____Age:_____________
City: _____________________ST: ________________Zip code: __________Date of Birth: _______________
In Case of Emergency Notify: ________________________________________________________________
Phone: ______________________________Relationship:_________________________________________
Signature: ___________________________________ Date: ________/________/____________________
Driver Biography
Occupation: ___________________________________________________ Years Racing: _______________
Spouse/Companion: _______________________________________________________________________
How Many Children: __________________ Girls __________________________Boys
Racing Goals:_____________________________________________________________________________
Hobbies:_________________________________________________________________________________
Comments:_______________________________________________________________________________
Email Address: ____________________________________________________________________________
Team Members
Name: ___________________________________ Duties: _________________________________________
Name: ___________________________________ Duties: _________________________________________
Name: ___________________________________ Duties: ________________________________________
Name: ___________________________________ Duties: ________________________________________
Sponsors
Primary: ________________________________________________________________________________
Secondary: ______________________________________________________________________________
Others: _________________________________________________________________________________
DUES $85/ Year $45/ One Day Make Checks Payable to: MAORA
Mail to: Heather Bruner
422 E. Main St.
DePauw IN, 47115
Recording Officer __________________________ Date _____/_____/_____
Approved? Yes or No
MID AMERICA OFF ROAD ASSOCIATION www.maoraracing.us
Email ____________________________________________________________
Team Name______________________________________Number______________Class__________
Name: __________________________________________Phone:__________________________________
Address: _______________________________________________________Sex:_____Age:_____________
City: _____________________ST: ________________Zip code: __________Date of Birth: _______________
In Case of Emergency Notify: ________________________________________________________________
Phone: ______________________________Relationship:_________________________________________
Signature: ___________________________________ Date: ________/________/____________________
Driver Biography
Occupation: ___________________________________________________ Years Racing: _______________
Spouse/Companion: _______________________________________________________________________
How Many Children: __________________ Girls __________________________Boys
Racing Goals:_____________________________________________________________________________
Hobbies:_________________________________________________________________________________
Comments:_______________________________________________________________________________
Email Address: ____________________________________________________________________________
Team Members
Name: ___________________________________ Duties: _________________________________________
Name: ___________________________________ Duties: _________________________________________
Name: ___________________________________ Duties: ________________________________________
Name: ___________________________________ Duties: ________________________________________
Sponsors
Primary: ________________________________________________________________________________
Secondary: ______________________________________________________________________________
Others: _________________________________________________________________________________
DUES $85/ Year $45/ One Day Make Checks Payable to: MAORA
Mail to: Heather Bruner
422 E. Main St.
DePauw IN, 47115
Recording Officer __________________________ Date _____/_____/_____
Approved? Yes or No
