<p> US Autobahn Series (USAS) Membership Application</p><p>Please fill out the membership application below, and indicate which race or races you are interested in attending. Upon receipt, we will immediately forward you a membership card and the entry forms and race materials you will need for the races you have selected.</p><p>Bonneville 100 _____ Pony Express 130 ______July 13-16, 2006 August 24 - 27, 2006</p><p>Do you need a race pre-run video? Yes______No______</p><p>MEMBERSHIP INFORMATION As per MKM Racing Promotion’s agreement with the Nevada D.O.T, all persons in a vehicle competing in the event must be paid members of USAS. Please check the appropriate membership box and fill in the corresponding section.  Individual Membership ($50 annually)  2nd Individual Membership ($50 annually) (Non-Family Navigator for listed driver) Name: ______Tel. #: ______Name: ______Tel. #: ______Address: ______Address: ______City: ______State: ____ Zip: ______City: ______State: ____ Zip: ______</p><p> Family Membership ($75 annually) Driver or Navigator (Circle One)  2nd Family Member Name: ______Tel. #: ______Name: ______Tel. #: ______Address: ______Address: Lifetime memberships are also available for $200. Lifetime members receive preference on grid reservations, and a permanent car number exclusive to them. Car numbers are available on a first-come, first-served basis. Immediate family members are also included in the membership. To become a lifetime member, check the box below and fill out the information section below instead of the one above.</p><p> Lifetime Membership (one-time payment of $200)  Car # desired______2nd choice______Name: ______Tel. # ______Address: ______City: ______State: ____ Zip: ______Email address: ______</p><p>METHOD OF PAYMENT:  Check  Money Order  Visa  Mastercard</p><p>Credit Card # ______Exp. ______</p><p>PRINT NAME______SIGNATURE______</p><p>For Information Call, Fax, Write or Email 8170 S. Eastern, Ste # 4-611 Las Vegas, NV 89123 Voice: 702-614-6108 Fax: 702-614-6109 Email: [email protected] www.openroadracing.com For Information Call, Fax, Write or Email PMB 611 8170 S. Eastern, Ste #4 Las Vegas, NV 89123 Voice: 702-614-6108 Fax: 702-614-6109 Email: [email protected] Visit us on the World Wide Web at www.openroadracing.com</p>