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RMMRA MEMBERSHIP APPLICATION
Name______________________________________________________________________
Circle Appropriate
Associate Member (club supporter) $25
Participating Member (voting) $40
the following catagories include participating membership fee
New Owner or Renewing Owner before Mar 15 $135
Renewing Owner after Mar 15 155
New Driver or Renewing Driver before Mar 15 $175
Renewing Driver after Mar 15 195
New Owner-Driver or Renewing Owner-Driver before Mar 15 $270
Renewing Owner-Driver after Mar 15 290
Owner, Driver, Owner-Driver Social Sec # or Tax ID #______________________________________________DOB_____________________
Will not be disclosed, except if required with IRS 1099 form, or for medical emergency.
Mailing Addr _______________________________________________________________
Phone H_______________________ W_____________________C_____________________
E-Mail addr _______________________________________________________________
Note We will not disclose above information to anyone, except other members, potential sponsors, promoters, etc who request it for valid club business. We will not disclose above in any circumstance, if you so indicate. Please do so here by inserting reference to which items you
want held in confidence._________________________________________________________
Supplemental, Secondary Medical Insurance is required for Drivers and Owner-Drivers, and is included in the membership fees above for them. All other members may elect the same insurance as an optional addition to their membership. This insurance is secondary to the member’s own medical insurance and race track insurance coverage. It will pay for medical expenses, with certain typical exclusions, after satisfaction of the first $10,000 of expenses by member and or track as a deductible, and after those other coverages expire, up to $100,000. RMMRA sanctions no events without track insurance of at least the $10,000 (which usually is also secondary to the member’s own insurance, if available). This coverage applies only at the race track at RMMRA sanctioned events.
Circle for Optional Supplemental Medical Insurance, non-driver _$ 111_____________
RMMRA carries a Liability Insurance policy which protects the club and its officers against certain legal risks. The cost for this policy is covered in the Owner and Owner-Driver membership fees.
Requested Car Number ________________ Alternate Request_____________________
Chassis and Engine _________________________ __________________________
Sponsors(to be published and provided to track announcers, programs, etc)_________________
_____________________________________________________________________________
_____________________________________________________________________________
Other Items of interest or note, which you may wish to make known for promotional purposes, such as Driving or Owner Championships, Your Occupation or Skills if available to benefit the Club gratis or for compensation, Rookie Status with or without other Race Experience, Interest in Volunteering as a Club Official, Tech Inspector, PR Representative, Sponsor, or other
____________________________________________________________________________
____________________________________________________________________________
Owners may register additional car or cars with separate car numbers to accumulate separate points. The cost for such additional cars, after first car from same owner is $ 95, per car.
(Back-Up cars need not be registered or paid fees for, in addition to the primary car, and may be used at any time, subject to Race Rules, ie start at back if used after qualifying, pass inspection, etc. Such back-up cars only accrue Owner points for the primary car of the same number).Separate Additional Cars for points for same Registered Owner
Car Number ____________Alternate ________ Circle $__95
Car Number ____________Alternate________ Circle $__95
Note Owners, Drivers, and Owner-Drivers may compete with RMMRA for up to two weekends, upon successful application to the President, Secretary, or Director of Competition without joining or paying membership fees to RMMRA, but must adhere to Rules. Such Guests will not accumulate points or contingencies toward year-end prizes, and may be required to pay temporary entry fees (rarely imposed, depending on circumstances), and are not covered under RMMRA Supplemental Excess Medical insurance. All guests for a particular race meet will be treated uniformly.
Total Amt Due = Sum of Circled amounts above = __________________________________
Check # ___________________________
Applicant Agrees to Abide by Published Rules of RMMRA as found in current Rule Book
Sign / Date ______________________________________________________________
Thank-You for your support of RMMRA
Please deliver application to Board of Directors Member, Membership Meeting, or Mail To
RMMRA
c/o 10304 Fox CtNorthglenn CO 80260
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