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Pittsburgh Circle Track Club
2015 Membership Application

Please print a copy of this form to complete it.
Pittsburgh Circle Track Club Dues:

   Individual - $20.00      Add a Spouse (for $5) - $25.00 (total)       Family - $30.00 (total)
   Name __________________________________________________________________  
   Spouse (to add a spouse) __________________________________________________   
   Children (for family membership) ____________________________________________
   Address ________________________________________________________________
   Phone Number __________________________________
   E-mail Address __________________________________
   _____ Owner     _____ Driver     _____ Pit Crew     _____ Fan

   Owners and drivers, please provide the following information:
   Car Number ______________       Division ____________________________________   
   Home Track _____________________________________________________________
   If Owner, Driver's Name____________________________________________________   
   If Driver, Owner's Name____________________________________________________   

          Please mail your completed membership form and fees to:
          Pittsburgh Circle Track Club
          c/o Jill Folkmire
          1006 Avacoll Drive
          Pittsburgh, PA 15220

          Please make checks payable to the Pittsburgh Circle Track Club.

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