MEMBERSHIP FORM
Terlingua Track Club		New Member	__
		Renewal	__
Dues are payable on a calendar basis. Individual dues: $20 Family dues: $25 Mail checks and this form to: Terlingua Track Club,c/o Dale Lee, 11425 32nd Avenue North, Texas City, Texas 77591
Name(s). List all participating Family members	Sex	Age	Date of Birth	HARRA Number
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Address: Street _______________________________________________________________________
City, State, Zip _______________________________________________________________________
Is this a new address? Yes __ No __
Home Phone __________________________________
Work Phone __________________________________
Fax _________________________________________
(Remember to include your area code)
Email address: ________________________________________________________________________