N.B.S.S.R

North Bay Snowmobile Speed Runs

2004 Membership Application

PLEASE PRINT AND COMPLETE THIS FORM THEN MAIL IT TO:

N.B.S.S.R

1115 Premier Road

North Bay Ont, Canada

P1A 2J2

Name

Address

Province/State                                                  P.C./Zip Code

Phone   (     )                                                                Fax    (     )

E-mail

PLEASE REGISTER THE CLASS OF YOUR SLED(S):

1. Up to 500 Stock                                9. 800 Stock                          17. Pro Stock 1000

2. Up to 500 Imp.                                10. 800 Stock s/p                     18. Pro Stock up to 1250

11. 800 Imp.

3. 600 Stock                                        12. 900 Stock                          19. Mod Full Body 1250-1500 turbo

4. 600 Stock s/p                                   13. 900 Stock s/p                     20. Mod Lay Down 1250-1500 turbo,

5. 600 Imp.                                          14. 900 Imp.

6. 700 Stock                                        15. 1000 Stock                        21. Open Mod Full Body 1500+

7. 700 Stock s/p                                   16. 1000 Imp.                          22. Open Mod Lay Down 1500+

8. 700 Imp.

23.four stroke class stock

YEAR

MAKE

MODEL

ENGINE SIZE

#CYLINDERS

#  PIPES

CLASS #

1.

2.

3.

4.

5.

MEMBERSHIP FEE:  $100.00 per sled Canadian funds GST included. We accept cash or cheques. Please make cheque payable to N.B.S.S.R.