Central States Association of Shrine Motor Corps
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CENTRAL STATES ASSOCIATION OF SHRINE MOTOR CORPS
$8.00 per member per year

REMITTANCE OF DUES prior to 1 March
pay $9.00 per member AFTER March 1st

Temple____________________________ City & State________________________

Name of Unit___________________________________________________________

Please circle all classifications that apply to your unit:

TWO WHEEL ONLY

Midget 0-100cc
Light Weight 101-249cc
Medium Weight 250-499cc
Lt Heavy Wgt 500-899cc
Heavy Weight 900cc & up
Harley Full Dress
Scooter Class
Un-Uniform (old Touring class - colors - etc.)

MULTI-WHEEL ONLY

Novelty
32 Roadsters
Mini T's
Mini Indy's
3 Wheel Small
4 Wheel Large
4 Wheel Small 0-150cc
4 Wheel Large 301cc & up  
SHOW CAR ONLY

Antique Cars
Modified
Special Interest
Convertible
Commercial
Mustang


Officer in Charge


Name:__________________
Address:________________
_______________________
Phone:_________________
email:__________________

President


Name:__________________
Address:________________
_______________________
Phone:_________________
email:__________________

Secretary


Name:__________________
Address:________________
_______________________
Phone:_________________
email:__________________

CSASMC Voting Rep._____________________________________
email address:________________________

Unit Membership - Please list all members and submit $8.00 per member to:

Noble Bradley Waite, Sec. CSASMC
926 South 41 Street
Omaha, NE. 68105
Make checks payable to CSASMC
Dues paid after March 1st  will be $9.00 per member.

 


NAME

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Purchase a CSASMC sportshirt

Order Forms through the links to the right>>>

 

  FORMS
    $40.00 Sport Shirt
    $35.00 Sport Shirt
    $25.00 Sport Shirt
  CSASMC Membership form
  Shriners Hospital Application form

 
 

Central States Association of Shrine Motor Corps
C.S.A.S.M.C. - A.A.O.N.M.S.
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