2012 HSTPA Membership form

Name:__________________________________________________

Address:______________________________________________

Email address_______________________________________

City: ____________________________State: ________Zip_________

Phone:______________________Cell Phone:______________________

Class:________Vehicle Name______________________________

NTPA#___________

2012 Membership fee $125.00 before March 1st $175.00 after March 1st.

If you wish to receive 2012 end of season point money, competitor
must post a additional $100.00 point money by April 1st, 2012

Make checks payable to HSTPA

Membership fee__________
         Point fee __________
               Total __________