IMCA Membership Application

IMCA MEMBERSHIP APPLICATION
Today's Date*

MonthDayYear
Date
New or Renewal Application*

RenewalNew Member
Division*

Modified $130Late Model $115Sprint Car $120Stock Car $110Northern SportMod $105Southern SportMod $105Hobby Stock $100Sport Compact $75Mod Lite $75Associate/Crew Member $75
Driver's Name*

First NameLast Name
Gender*

MaleFemale
Member ID Number (5 digit number on license, if previous member)
Spouse Name

First NameLast Name
Driver's Birth Date*

MonthDayYear
Age
Minor Application Fee (ages 14-17)*
Age in Days
Address*

Street Address

Address 2/PO Box

CityState / Province

Postal / Zip Code
Primary Phone Number*
Secondary Phone Number
E-mail (required)*

Confirmation Emailexample@example.com
Car #*
Rookie

YesNo
Do you need a decal packet?*

YESNO
Jacket Size*

SmallMediumLargeXL2XL3XL4XL5XL6XL
Will you be running a crate motor?*

YESNO
Rookie status must be declared by July 1. All drivers must send photo of car with required decals to cbgramm@imca.com to be eligible for contingencies and point fund.
IMCA membership for 2025 includes a $100,000 excess medical insurance policy ($5,000 deductible) which covers you at any IMCA sanctioned event. This excess medical coverage goes into effect after the $5,000 deductible has been met, per the terms and conditions of the policy, as a result of an IMCA sanctioned racing accident, up to $100,000. This excess medical coverage is over the track insurance and any other valid and collectible insurance that you, the IMCA member, may have. A $10,000 accidental death, dismemberment and paralysis policy is also included for IMCA sanctioned events, or for travel to or from IMCA sanctioned events. The policy period is from 1/1/25 to 12/31/25.
Signature*

Clear
Total

Payment Processing*

USDTotal Charges, Plus $5.95 Card Processing Fee

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

IMCA MEMBERSHIP APPLICATION