Member Registration Form

    :::WANT MORE INFO ABOUT THE DRTC?:::

    FEEL FREE TO CONTACT YOUR REGIONAL REP.     WITH ANY QUESTIONS OR CONCERNS YOU HAVE     ABOUT THE DAKOTA R/T CLUB. IF YOU NEED TO     FIND OUT WHICH REGIONAL REP. TO CONTACT     PLEASE CLICK THE BUTTON BELOW FOR INFO ON     WHAT REGION YOU ARE IN AS WELL AS YOUR     LOCAL REPRESENTATIVES CONTACT INFO.


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PERSONAL INFORMATION
* REQUIRED INFORMATION

   NAME:       *   EMAIL: *

   ADDITIONAL NAME ON CARD (OPTIONAL):

   ADDRESS: *   PHONE:     *

   CITY:         *  STATE: *    ZIP: *

TRUCK INFORMATION
* REQUIRED INFORMATION

   VIN #:     *   MODEL: *   TRIM: *

   YEAR :      *   CAB TYPE: *   COLOR: *

   DRTC STICKER COLOR (ARRIVES WITH YOUR MEMBER PACAKAGE): *

I'M PRINTING THIS FORM AND MAILING PAYMENT VIA USPS (PRINT THIS PAGE NOW BEFORE SUBMITTING THE FORM)
I HAVE REGISTERED ON THE FORUM AND WILL PAYPAL VIA THE FORUM (CLICK SUBMIT TO GO TO THE PAYMENTS PAGE)