2021 Dixie Shootout Membership Form

The Dixie Shootout Membership is an annual $50 per family charge. By joining the Dixie Shootout Regional Series you are agreeing to abide by the rules set by the Dixie Shootout Board, which are subject to change with adequate notice to all members. You can find the 2021 rules located on the website under About -> Rules.

In order to race in the Dixie Shootout series, you must also be a USAC .25 member and a member of a local USAC sanctioned track. Please make sure to have these memberships completed prior to the first Dixie Shootout race of 2021.

When applying for membership, you are granting permission to Dixie Shootout Regional Series to publish any photos or any videos taken by or for the Dixie Shootout Regional to any form of media that Promotes the Dixie Shootout Regional Series. In the event you do not wish for photos or videos to be published, please contact regional secretary at secretary@dixieshootout.com.
Track Information
Home Track*
- HQMA (Hunstville)
- MAQMA (Metro Atlanta)
- MCQMRA (Nashville)
- NCQMA (No. Carolina)
- NGQMA (No. Georgia)
- NSQMRA (New Smyrna)
Primary Handler Information
Please use the same primary handler name and email on your membership as what you will use on your race registrations. This allows us to easily verify that you are a Dixie Shootout member when you register for each race.
Primary Handler First Name*
Please use the same name as the primary handler you will
Primary Handler Last Name*
use on your race registrations, if at all possible.
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*

Please use the same email here as you will use on your race registrations, if at all possible.
Driver Information
Driver 1 First Name
Driver 1 Last Name
Driver 1 Birthdate*
Date Format: MM slash DD slash YYYY
Driver 2 First Name
Driver 2 Last Name
Driver 2 Birthdate*
Date Format: MM slash DD slash YYYY
Driver 3 First Name
Driver 3 Last Name
Driver 3 Birthdate*
Date Format: MM slash DD slash YYYY
Alternate Handler
Alternate Handler 1 First Name
Alternate Handler 1 Last Name
Alternate Handler 2 First Name
Alternate Handler 2 Last Name
Alternate Handler 3 First Name
Alternate Handler 3 Last Name
Total
2021 Membership*
Price: $50.00
Thank you for your Dixie Shootout Annual Membership. Your membership is not complete until you select the submit button below and finalize your payment via Paypal.

We continually strive to improve the series and welcome your feedback. If you have any suggestions or comments please e-mail secretary@dixieshootout.com.

We look forward to a great 2021 season!
Total
$0.00

2021 Dixie Shootout Membership Form

Track Information

Primary Handler Information

Driver Information

Alternate Handler

Total