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Event Management & Marketing, PO Box 21311, Columbus, OH 43221 / Ph: 614-268-1181 / Mon-Fri 10am-5pm
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Jeff Johnson Motorsports LLC
Registration for NNPSA Membership
We offer two ways to register:
Use the On Line Registration Form Below
print the form below, fill out and mail to:
Jeff Johnson Motorsports, PO Box 21311, Columbus, OH 43221
On Line Registration for NNPSA Membership
Contact Information:
Name:
Address 1:
Address 2:
City:
State:   Zip:
Email address:
Phone:

Select Membership:
Active membership - $50.00
T-shirt size: Sm Med Lg XL
Active membership renewal - $15.00
Supporting membership - $15.00
Quantity additional decals - $5.00 ea
Professional membership - Free
Track Operator Press
Fabricator/Builder Former Driver/Owner

Vehicle you are registering:
Year: Make: Model:
Chassis: Back Half Tube Outlaw/Top Sportsman
Was your car raced originally? Yes No
If yes, in which categories:
Pro Stock Altered Gas Modified Production
Original driver
Builder
Team
Years Raced
Sanctioning Body
Division
Are you converting an existing race car to Nostalgia Pro Stock trim?
Yes No
Are you building a Nostalgia Pro Stock from scratch? Yes No
Is your car finished? Yes No - If not when?
Are you interested in racing or showing your car?
Race Show Unsure
Assuming there are events within a reasonable distance of you, do you anticipate participating this year?
Yes No - If not when?
All contact information will remain confidential.

Additional Comments:

Payment Information
Send me a PayPal invoice

Type of payment: Credit/Debit Card
Type:    VISA     MasterCard

Card Number:
Expiration Date:
(eg. 06/19)

If you would prefer, you may print this page and mail to:
PO Box 21311, Columbus, OH 43221

Thank You!
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