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2011 SEMRA Competition
License Application


   
First Name
Last Name
Address
City
State
Zip
Phone
E-mail
EMERGENCY CONTACT
Name
Phone
Have you ever held a roadracing license?
Yes No Organization
Requested number
Option #1
Option #2
Option #3
Date of Birth

 

*Single day license is valid for one event per season per person, $30 balance will be required at second attended event.

  2 -  Mail check or money order made out to: SEMRA

If you are under 18 you legally can't agree so you must have a parent or guardian sign the printable version and mail it in.

 
Southeast Mini Roadracing Association, LLC
c/o Paul Wilson
98 Summer Creek Dr.
Dallas, Ga. 30157

Must be postmarked 10 days prior to event date. No exceptions. Dishonored checks will incur a $35.00 fee and be posted at registration desk.

Send mail to webmaster@semra.org with questions or comments about this web site.
Copyright © 2010 Southeasten Mini Roadracing Association, LLC
Last modified: 10/21/2010