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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

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