Please circle all classifications that apply to your unit:

TWO WHEEL ONLY Midget 0-100cc Light Weight 101-249cc Medium Weight 250-499cc Lt Heavy Wgt 500-899cc Heavy Weight 900cc & up Harley Full Dress Scooter Class Un-Uniform (old Touring class - colors - etc.)

MULTI-WHEEL ONLY Novelty 32 Roadsters Mini T's Mini Indy's 3 Wheel Small 4 Wheel Large 4 Wheel Small 0-150cc 4 Wheel Large 301cc & up

SHOW CAR ONLY Antique Cars Modified Special Interest Convertible Commercial Mustang

Officer in Charge Name:__________________ Address:________________ _______________________ Phone:_________________ email:__________________

President Name:__________________ Address:________________ _______________________ Phone:_________________ email:__________________

Secretary Name:__________________ Address:________________ _______________________ Phone:_________________ email:__________________

CSASMC Voting Rep._____________________________________
email address:________________________

Noble Bradley Waite, Sec. CSASMC
926 South 41 Street
Omaha, NE. 68105
Make checks payable to CSASMC
Dues paid after March 1st  will be $9.00 per member.

NAME

1._________________9__________________17_________________25________________

2._________________10_________________18_________________26________________

3._________________11_________________19_________________27________________

4._________________12_________________20_________________28________________

5._________________13_________________21_________________29________________

6._________________14_________________22_________________30________________

7._________________15_________________23_________________31________________

8._________________16_________________24_________________32________________

OVER

updated June 29, 2006