|
Adobe PDF Document
CLICK HERE
if you don't have Adobe click on the icon to get it
CENTRAL STATES ASSOCIATION OF SHRINE MOTOR CORPS
$8.00 per member per year REMITTANCE OF DUES prior to 1 March
pay $9.00 per member AFTER March 1st
Temple____________________________ City & State________________________
Name of Unit___________________________________________________________
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:________________________
Unit Membership - Please list all members and submit $8.00 per member to:
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________________
|
