Name                   *

Street Address            *

City, State, Zip code   *

Business Name           

Business Address      

Business Phone         

Business Fax              

Business Web Page   

E-Mail Address           *

Join Which MSPA Category                               Automotive Media Electronic Media MotorSports Media Photographer Writer

MEMBERSHIP IS BASED ON MATERIALS SUBMITTED THAT SHOW THE APPLICANT HAS BEEN PUBLISHED IN LOCAL OR NATIONAL PRINT OR ELECTRONIC MOTOR SPORTS MEDIA.  HARD COPIES SHOULD BE SENT TO BETH GRIBBIN. OR, LINKS TO WEB SITES WHERE COPIES CAN BE FOUND SHOULD BE INCLUDED IN THIS APPLICATION.  MEMBERSHIP WILL NOT BE APPROVED UNTIL THE BOARD OF DIRECTORS HAS LOOKED AT ALL MATERIAL SUBMITTED AND APPROVED THE APPLICANTION.