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MSRA’s “Back to the 50’s Weekend” • 2016 Page 41<br />
Forget Something?<br />
MSRA Membership Application<br />
Steichen’s is a real, honest-to-goodness grocery<br />
store, filled with everything you find in a local grocery<br />
store. You’ll be able to get all medical aids,<br />
photo supplies, snacks and even deli meals at the<br />
store. Steichen’s will be located at both ends of<br />
the Fairgrounds ... in the Progress Building and<br />
a block from the cattle barns behind the poultry<br />
building. We welcome Steichens back for the fifth<br />
year!<br />
Minnesota Street Rod Association<br />
Membership Application<br />
Name<br />
Other Adult<br />
Address<br />
City<br />
State<br />
Zip<br />
STREET ROD INFORMATION:<br />
(Include year, make and model.)<br />
Vehicle ________________________________________<br />
Vehicle ________________________________________<br />
Vehicle ________________________________________<br />
Vehicle ________________________________________<br />
Email<br />
Optional: Children (under 18 or 21 if attending college)<br />
AMT. CK. #<br />
DATE MEM. #<br />
Phone ( )<br />
Car Clubs<br />
Are you a previous MSRA member? q Yes q No<br />
If “yes” Past MSRA Member #<br />
U.S. FEES INTERNATIONAL FEES<br />
Joining in:<br />
Jan.-Sept. ....................... $45.00 ................. $75.00<br />
Oct./Nov./Dec.** ............. $45.00 ................. $75.00<br />
**(INC. FOLLOWING YEAR)<br />
Lifetime membership ..... $750.00 .............. $1500.00<br />
August 15 - September 30 –<br />
Membership applications will not be processed<br />
MSRA<br />
P.O. Box 125, Circle Pines, MN 55014<br />
Memberships expire December 31st of each year.<br />
MSRA CHANGE OF ADDRESS FORM<br />
30 Day Notice for change of address will ensure timely receipt of MSRA mailings<br />
New address effective date __________________<br />
Are you a “Snowbird”? If so, anticipated return date __________________<br />
MSRA Membership Number: ______________<br />
Name: ___________________________________________________________________________<br />
New Address: _____________________________________________________________________<br />
City: _______________________________________ State: __________ Zip: _______________<br />
Phone: (______)___________________________________________________________________<br />
Mail to: MSRA Change of Address<br />
PO Box 125 • Circle Pines, MN 55014<br />
GDI No. 89778 8/2015