Dear Prospective SCCA Member:

To apply for membership in the Sports Car Club of America, the world's largest member participation automotive organization, please print and complete the form in full and return, with payment, to: Norma Williams, 2701 W 47th Street, Westwood, KS 66205.
If you have questions, please call ( 913) 262 6300.

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Name ________________________________________________________   Date of Birth _______________
Address ______________________________________________________   Telephone ________________
City ______________________________________________________ State ______  Zip ________________
Business Address _______________________________________________  Telephone________________
City ______________________________________________________ State ______  Zip________________
Occupation ______________________________   Single   Married: Spouse's name__________________

Which address would you like mail sent to, and which phone number, or both, would you prefer to be listed in the Region roster?    Mail:   Home    Work     Telephone:    Home    Work    Both

What areas of SCCA activities are you most interested in?
  Pro Racing   Club Racing   Road Rally   Pro Rally
  Solo   Worker/Official   Other______________________________
Membership in the Sports Car Club of America is dual - National and Regional. Dues are for one (1) year from the date of payment. Make one check/money order for the total amount payable to SCCA, Inc.
Office Use Only
Annual National Dues
Annual KC Dues
 Total
Regular member $45 Regular member $15 $60
Spouse $10 Spouse $5 $75
Family membership $70 Family membership $20 $90
Spouse must be regular member's spouse.
If applying for family membership (husband, wife and children), indicate names and date of birth of children under 21:
Name__________________________________ DOB______________
Name__________________________________ DOB______________
Name__________________________________ DOB______________
Name__________________________________ DOB______________

I hereby apply for membership in the Sports Car Club of America, Inc., and its Kansas City Region and agree to abide by the bylaws. I require the following type of membership:
  Regular member - $60   Regular member and spouse - $75   Family - $90
Applicant's signature______________________________ Date_________________
  Enclosed is my check or money order for $__________
  Visa________________________________________ Expiration_____________
  Mastercard___________________________________ Expiration_____________