Date:_________                     

$25 per person if paid on or before February 28, 2010
$30 per person if paid after February 28, 2010. 
Points will not start until membership dues have been paid.


PSKA Membership 
  
_________________________________
Name
 
____________________________________
Address
 
____________________________________
City                                 State               Zip
 
Phone #  (_____)_______________________
 
____________________________________
e-mail address – Only if you wish to receive mailings
 
_________          _______________
kart #                 Class(es)