2017 WUMPA MEMBER APPLICATION 

DRIVER NAME _____________________________________   AGE_____________

STREET ADDRESS ______________________________________ CITY_____________________________   STATE_______     ZIP______________ 

PHONE (home) ________________________(cell)________________________

E-MAIL__________________________________________________________

Vehicle Name___________________________________________________

VEHICLE MAKE/MODEL _________________________  YEAR __________________

ENGINE SIZE_____________________    TRANS________________________     

 

LIST SPONSORS BELOW:    

 

 

 

 

 

Membership Fees: $20.00  Plus $25.00 Per Class For Points                                         Date Paid_________

Membership & Points Fees must be Paid 7 days before the first pull of the year or Points Will Not Be Recorded. It not paid 7 Days Before the first pull Add $10 to Each Fee. The points will be started after all fees are paid.

 

Circle Your Class or Classes:

5000# Stock               5500# Stock                    6000# Stock             6200 Street Stock    

          6200# Open Stock                   6200# Super Stock               6200# Modified                                                       

 

Make checks payable to WUMPA    

Mail Application and Check for Membership & Points Fees to:

Gary Chartier

N4393 Highway 180

Marinette, WI 54143