MSRA CHANGE OF ADDRESS FORM 45 DAY NOTICE REQUIRED for change of address will ensure timely receipt of MSRA mailings.
MSRA Membership Application
Minnesota Street Rod Association Membership Application
NOTE: PRICE CHANGES!
PLEASE PRINT CLEARLY.
Name
Spouse
Address
City
State Zip
Email
Optional: Children( under 18 or 21 if attending college)
Phone()
Car Clubs Are you a previous MSRA member? q Yes q No
STREET ROD INFORMATION:
( Include year, make and model.)
Vehicle ________________________________________ Vehicle ________________________________________ Vehicle ________________________________________ Vehicle ________________________________________
AMT. CK. # DATE MEM. #
RENEWAL **: U. S. RENEWAL $ 40.00 INT’ l. RENEWAL $ 70.00
NEW MEMBER **: U. S. NEW $ 50.00 INT’ L. NEW $ 85.00
During Oct./ Nov./ Dec.**(** INCLUDES FOLLOWING YEAR)
LIFETIME MEMBERSHIP: U. S. LIFETIME $ 750.00 INT’ L. LIFETIME $ 1500.00
If“ Yes” Past MSRA Member # If“ Yes” renewal fee is: U. S. = $ 40.00 • International = $ 70.00
GDI No. 89778 10 / 2024
Membership applications will not be processed August 15- September 30
MSRA Membership PO Box 431, Hastings, MN 55033 Memberships expire December 31st of each year.
MAIL FORM ALONG WITH PAYMENT TO:
MSRA CHANGE OF ADDRESS FORM 45 DAY NOTICE REQUIRED for change of address will ensure timely receipt of MSRA mailings.
Please be sure to let us know whenever you are on the move with a 45 day advance notice. LineChasers ARE NOT forwarded by the Post Office. You can notify us either by this form or by email: msramembership @ gmail. com with the same information listed on this form.
INFORMATION WE MUST HAVE: MSRA Membership Number: _____________
Please include this information, we have members with the same names, to be sure that we are updating the correct member.
Name: ________________________________________ Current Address: _______________________________ City: __________________________________________ State: _____________________ Zip: _______________ Phone:(______)_________________________________
Mail to: MSRA Change of Address PO Box 431 Hastings, MN 55033 q PERMANENT ADDRESS EFFECTIVE DATE:
_______________ NEW Address: __________________________________ City: __________________________________________ State: _____________________ Zip: _______________ Phone:(______)_________________________________
q SNOWBIRD / TEMPORARY ADDRESS Begin date:
_______________
End date( if known):
_______________ Temporary Address: _____________________________ City: __________________________________________ State: _____________________ Zip: _______________ Phone:(______)_________________________________
MSRA’ s“ Back to the 50’ s Weekend” • 2025 Page 51