Desert Air Riders Roster Administration - Detail

DAR Roster -
First Name     [Required]
Last Name     [Required]
USHPA #     USHPA membership number or 0 if non-USHPA member
Address      
City      
State     2-character state abbreviation
Zip      
Home Phone     555-555-5555
Cell Phone     h, w, etc.
Email     myemail@somewhere.com
Dues     0 or 20
Dues Paid Thru     4-digit year
Image     *.jpg
Active     Uncheck box for inactive former members
USHPA Exp.     Expiration Date from USHPA website