Adirondack Motor Enthusiasts Club, Inc.

2007 Special  Registration/Membership  Form  for Historic Racers

PLEASE PRINT CLEARLY

Name_________________________________________________                Car number__________

Street/Mailing Address_________________________________________              Apt.#__________

City____________________________________________          State_____       Zip______________

Phone (day)_________________ (eve)__________________ E-Mail__________________________

Do you have a valid driver's license?____________        State______        Date of Expiration__________

Car Year/ Make/Model___________________________________               Color_________________

Class (Check One)   Screw Tires________          Street Studs _________        Rubber to Ice___________

How did you learn about A.M.E.C.? Friend, website, magazine, email list, message board forum?__________________________________________________________________

_______________________________________________

Emergency Contact
                      Name________________________________________Phone(1)__________________________

Relationship__________________________________Phone (2)_________________________

Membership and Event Fees: (Check one or both)

We are offering a special package deal incentive for Historic racers. This includes a temporary

 membership for the weekend and all entry fees for the races for just $45.00 ________

Optional: If you’d like to join A.M.E.C. and become a year round member, 

the fee is just $20.00 annually. __________

Saturday night dinner buffet and awards banquet in the Holiday Inn

                                         Tickets are $30 per person __________

Total amount [Payable at morning race registration] $______

Or in advance: Make checks payable to: A.M.E.C.

Send to: Michael Kamm

15 Cayuga Court

Averill Park, NY 12018