q Racing and Voting              q Associate (non-racing, non-voting)

APBA # __________________________________     Birthdate _________________________

Name:  ______________________________________________________________________

Address:  ____________________________________________________________________

City:  _______________________________     State:  ______________    Zip:  ____________

Home Phone:  __________________________    Work Phone:  ________________________

Fax:  ___________________________________   E-mail: _____________________________

Recommended By:  ___________________________________________________________

I expect to run the following classes: _____________________________________________

Fees:   

            Racing/Voting membership $20.00

                        Acceptance of this application entitles the above member to equal rights and

                        privileges with all other members of the association.

            Associate membership (non-racing, non-voting) $5.00

                        Acceptance of this application entitles the above member to the rights and

                        privileges of all other members of the association with the exception above

                        member may not (with this membership as their only club affiliation) race in

                        sanctioned events nor may the above member vote in any club election or ballot.

Please make check payable to:                               N.C.O.A.

Mail this application and payment to:                    N.C.O.A.

                                                                        c/o Nan Rasmussen

                                                                        1117 Wickford Circle

                                                                        Modesto, CA  95355