Membership Applications

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 Northwest PA Truck & Tractor Pullers Association
2019 MEMBERSHIP APPLICATION
*This application must be filled out in its entirety for your membership to be accepted.

Applicant’s Name:________________________________________

Applicant’s Address: _________________________________________

City ______________________State__________ Zip_________

Telephone Number: Home phone ______________________ Cell phone ___________________

E-mail Address:______________________________ (used for club/event news)

Information on Pulling Vehicle:
Class you are competing:
TRUCKS  TRACTORS

_____PURE STREET GAS 4X4 - 6500#                                 ______V-8 ANTIQUE - 6500#
_____PERFORMANCE STREET GAS 4X4 - 6500#                  _____LIMITED MODIFIED GAS 4X4 - 6500#                                                                                                                                         ______HOT FARM - 10000#
___    8200 Open Street Diesel  - 8200#                                   ______SINGLE ENGINE MODIFIED - 7200#
_____3.0 DIESEL 4X4 - 8000#                                                                      ______NW TOUGH FARM - 7000#, 8000#
_____STREET STOCK SEMI - 20000#                                                            HEAVY TOUGH FARM 10,500#, 12,500#

Name of Pulling Vehicle:____________________________________
Make: ___________________________ Model: _____________________ Year: ____________
Cubic Inches: __________   Color _____________    If truck, Cab:   __Crew __Ext. __Reg.
____$40.00– Competing Points & Voting Member paid on/before May 14, 2019
____$40.00– Competing Points Member (Non-voting rights) paid after May 14, 2019
____$20.00– General Voting & Social Member paid on/before May 14, 2019
____$20.00– Social Member (Non-voting rights) paid after May 14, 2019

I HEREBY give Northwest Pennsylvania Truck & Tractor Pullers Association and ALL PULLING VENUES, their assigns, licensees, and legal representatives the irrevocable right to use my name, picture, or photography in all forms and media and in all manners, including composite, for advertising, for publication or any other lawful purposes, and I waive any right to inspect or approve the finished product, including written copy, which maybe created in connection there within.

Please check:
I have read, understand, and agree to the policies of the Northwest Truck and Tractor Pullers general rules.

____________________________________________       _______________________
Applicant’s signature                                                             Date

Please send application and money to:  Northwest PA Truck & Tractor Pullers Assn., Inc.
(OR bring to May meeting)                           P.O. Box 145
                                                                       Jamestown, PA  16134-0145
Please make checks payable to:  Northwest Pullers 
##################################################################################
This is to Certify that  $__________ has been received from __________________________ for One (1) Competing or Social Membership in the Northwest PA Truck & Tractor Pullers Association, Inc. for the 2019 pulling season.

__________________________________________                       ______________________
Signature of Officer                                                                                                  Date