MemberShip Form

Start a new membership with FKA! It's quick and easy. Just fill out this form and mail in today!

FKA Membership fee is only $35.00 per year. Additional Family Members are only $10.00 each.

MEMBER INFORMATION:
Please print clearly to guarantee proper spelling of your name. Members under 18 years of age must have parental consent and copy of birth certificate. Print this form and mail in to register!

Name: ________________________________ Age: _______ Birth Date: __________________________

Address: _________________________________ City, State, Zip: _____________________________

Home Phone: _____________________ Email Address: _________________________________________

Business Phone: _______________________ Employer: _____________________________________

Health Insurance Company: _____________________________________________________________

Additional Applicant Name:________________________________________DOB:____________________

Dues are for a 12-month period. As a member of the FKA Racing, Inc., I have read and agree to abide by the rules and regulations of the Association. I understand that my membership entitles me to participate in all events sanctioned by the FKA and that I will receive a membership card and any FKA publications for the members of the Association.

Signature: ____________________________________________ Date: _________________________

Witnessed by: _________________________________________________________________________

Total Amount Paid: $_______________


MAKE CHECKS PAYABLE TO FKA. MAIL TO: JUDY SIMS, 3994 NW 36 Loop, JENNINGS, FL 32053

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FKA Racing, Inc. - Receipt for Membership (FKA use only)

Name: ________________________________________________ Amount Received:_________________

Received by: ____________________________________ Date:_______________________________