MINNEAPOLIS PISTON POPPERS, INC.
MEMBERSHIP FORM

NAME:  
A.M.A #:  
MAILING ADDRESS:  
CITY:  
STATE:  
ZIP CODE:  
PHONE #:  
E-MAIL:  
MEMBERSHIP TYPE:
(circle one)		 NEW MEMBER          RENEWAL
AGE GROUP:
(circle one)		 19 YEARS AND YOUNGER ($5.00)          20 YEARS AND UP ($35.00)
INTERESTS?
(circle all that apply)
COMBAT STUNT RACING
     
CARRIER SPEED SCALE
     
SPORT R/C FREE FLIGHT
     
OTHER:___________________________________

© 2005
Minneapolis Piston Poppers, Inc.