WISCONSIN GARDEN TRACTOR PULLERS, INC.
MEMBERSHIP APPLICATION AND LIABILITY RELEASE FORM
Name:______________________________________
Age:_______
No. of Yrs. Pulling:_______
Address:____________________________________
Phone #:______________________________
City:___________________________
State:_______
Cell Phone #:
_________________________
Zip Code: _______________
Email:
________________________________
Classes to choose from:
Stock =
(S)
Lt. Pro Mod = (LPM)
Pro Stock =
(PS)
Heavy Pro Mod = (HPM)
Lt. Super Mod =
(LSM)
Heavy Super Mod = (HSM)
Open Super Stock =
(OSS)
Outlaw = (O)
Unlimited Outlaw =
(UO)
Heavy Unlimited Outlaw (HUO)
| 1st Tractor Class(es): __________________________________ |
2nd Tractor: Class (es): __________________________________ |
| Tractor Name: ______________________________ | Tractor Name: ______________________________ |
| Tractor Make & Model: ____________________________________ |
Tractor Make & Model: ____________________________________ |
| Engine Make & Size: ______________________________________ |
Engine Make & Size: _____________________________________ |
| Other Tractor Info (fuel,
modifications): ______________________________________________ ______________________________________________ |
Other Tractor Info (fuel,
modifications): ____________________________________________ ____________________________________________ |
Misc. Information (Owner/Builder, sponsors, Awards, Championships, etc):______________________________
_____________________________________________________________________________________________
Waiver: (Note: Parent or Guardian must sign for minor child)
I agree to indemnity Wisconsin Garden Tractor Pullers, Inc.
(Club) and all of its related organizations (Promoters and Weight Transfer
Machine Owners/Operators), directors, officers, and volunteers, and hold same
harmless from and against any and all damages, liabilities, costs and expenses
(including but not limited to attorney's fees) which may be incurred as a result
of my participation in any Club event or activity.
I agree that by signing this from I release and discharge Wisconsin Garden
Tractor Pullers Inc., its directors, officers, members, owners/operators of the
weight transfer Machine, and Promoters of W.G.T.P. pulls from any and all known
or unknown damages, injuries, losses, judgments and/or claims from any causes
whatsoever, that may be suffered by entrants, family members, or guests while
attending or participating in said events. I also understand that each
participant will be solely responsible for his/her own vehicle and personal
property.
I state that I am of lawful age and legally competent to sign this document; that I understand the terms herein; and that I have signed this document as my own free act.
Name (print): _______________________________________
Signature: ________________________________ Dated: ____________
Accepted on behalf of W.G.T.P. INC. by:
___________________________________
Title: __________________________________ Date:
________________________