Minnesota Street Rod Association

Membership Renewal by Mail

Memberships Expire December 31 Each Year!

Click on the boxes below, enter information requested, print completed application
& mail with check or money order to the address provided at the bottom:

Personal Information:

First Name:

Date of Birth:

/ /
     (Mo / Day / Year)
Last Name:
Spouse: Children's Names:
Address: Phone:

Area Code:
Number:    

Address:

Nickname:

City: I belong to the following car clubs:
State:

Zip Code:

Have you been a member of the MSRA in the past?
Country: If yes, what was your MSRA Number?

Vehicle Information:

Vehicle 1: Coupe

 2 Door Sedan
 4 Door Sedan
 Convertible

 Roadster

 		Sedan Delivery
 Pickup
Vehicle 2: Coupe

 2 Door Sedan
 4 Door Sedan
 Convertible

 Roadster

 		Sedan Delivery
 Pickup
Vehicle 3: Coupe

 2 Door Sedan
 4 Door Sedan
 Convertible

 Roadster

 		Sedan Delivery
 Pickup

Membership Fee:

Annual
Membership:

 √ Fee:
US Dollars		 Joining MSRA allows full membership benefits through December 31 of the current year.  This includes all member functions, as well as receipt of the MSRA monthly LineChaser® publication.
USA

$25.00

USA resident only.
Canada: $30.00 Canada resident is $5.00 additional.
 

Lifetime Membership:

√

Fee:
US Dollars

 Lifetime membership in the MSRA allows full membership for life.  This includes all member functions, as well as receipt of the MSRA monthly LineChaser® publication.
USA

$450.00

USA resident only.
Canada:

$500.00

 Canada resident is $50.00 additional.

The Section Below is to be completed by the MSRA:


Date application received: ___________________

Amount Enclosed: __________________________		   
 Check #:__________

Date membership was processed: _____________		   
 MSRA #: __________

Make Check or Money Order Payable to MSRA
& Mail to:

Minnesota Street Rod Association

PO Box 426

Forest Lake, MN 55025-0426
USA