PERSONAL INFORMATION:

Full Name: ________________________Last Name:_______________________

Preferred Mailing Address:____________________________________________Date Of Birth______________________________
City: ________________________________ State/Province: ______________________ Zip/Postal Code: _________________
Country: ________________________Telephone: (______)__________________ Telephone: (______)____________________
Email: __________________________________________________________________

Registration Fees (All fees listed in U.S. Funds.) Includes car decals, t-shirts, hats, and membership fees.

PLEASE CHECK APPROPRIATE REGISTRATION FEE: MONTLY ACCESSORIES

Membership  $30
Decals  $20+(depending on size)
t-shirts  $10 Size_______ Qty._____
Student  $20
Processing fee $20 (non-refundable after 5 days) TOTAL $ ____________

*Cancellations/Changes and Refunds: Fees for missed membership, leaving crew will not be refunded. Fees will be refunded, less a $20.00
processing fee, if cancellation or change resulting in a refund is received in writing no later than 5 days. After that date of submission, fees are non-
refundable. All refunds will be processed after the submission of this form.

CAR INFORMATION:

Make:_____________ Model:______________ Color:__________ Year:_______ Plate Number:_____________

Make:_____________ Model:______________ Color:__________ Year:_______ Plate Number:_____________

*All vehicle information is stored in a file in case of any emergency and is not shared by anyone.

RULES / REGULATIONS

I_____________________ HAVE READ AND UNDERSTOOD THE RULES/REGULATIONS ON

THE________DAY OF_________YEAR OF_______. BY SIGNING THIS DOCUMENT I AGREE TO
ABIDE BY ALL RULES/REGULATIONS UNDER THE Snake Eyes Performance.

X X
MEMBER SIGNATURE BOARD MEMBER SIGNATURE

CLUB PRESIDENT: Edward Berlanga VICE PRESIDENT: ERIK TIETZ

Phone: (832) 829-9183 Phone: (832) 955-3945
Facebook: Snake Eyes Performance Facebook: ERIK TIETZ
Email: snakeeyesperformance@gmail.com Email: snakeyespeerformance@gmail.com