Nostalgia Gassers Racing AssociationMembership Application

You do not need to own a Gasser in order to be eligible for membership. For complete details on membership benefits please refer to our association website at www.nostalgiagassers.com.

Date: ____________

Name: _____________________________ Nickname:_______________________

Address: ___________________________________________________________

Email: _____________________________________________________________

Primary Phone: ( ) _______________ Alt. Phone: ( )_________________

Car/Driver: $60 yearly Associate Membership: $25 yearly

Amount Enclosed: ( ) $60 ( ) $25

If you wish to register and run a Gasser with our group, please visit the website, download and complete our Gasser Qualification Tech Form.

Please mail your competed membership application to: Nostalgia Gassers Racing Association7252 East 2900Kewanee, IL 61443

Rev 01/2016