Membership Application*

Team Name:                                                                               

Requested Number:                                         

Driver Name:                                                                              

Address:                                                                                           

City:                                           Tel:                                                

Zip Code:                                  Email:                                            

Sponsors:                                                                                  

Annual Membership Fee:   Pro - $75.00, Amateur - $40.00

Checks made to:
N.E.G.D.S.
P.O. Box 92
Colebrook, NH  03576