Pittsburgh Circle Track Club

Pittsburgh Circle Track Club
Membership Application

   Individual - $20.00      Add a Spouse (for $5) - $25.00 (total)       Family - $30.00 (total)

   Name __________________________________________________________________

   Spouse (to add a spouse) __________________________________________________

   Children (for family membership) ____________________________________________

   Address ________________________________________________________________

   Phone Number __________________________________

   E-mail Address __________________________________

   _____ Owner     _____ Driver     _____ Pit Crew     _____ Fan

   Owners and drivers, please provide the following information:

   Car Number ______________       Division ____________________________________

   Home Track _____________________________________________________________

   If Owner, Driver's Name____________________________________________________

   If Driver, Owner's Name____________________________________________________

          Please mail your completed membership form and fees to:

          Pittsburgh Circle Track Club
          c/o Dave Olivieri
          203 Olde Ingomar Ct.
          Pittsburgh, PA 15237

Please make checks payable to the Pittsburgh Circle Track Club.

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