Thumb Tractor Pulling Association Inc

2016 MEMBERSHIP APPLICATION Thumb Tractor Pulling Association Inc. 4004 Forester Road, Deckerville MI 48427 810-537-1137 ALL MEMBERSHIPS ARE NON-REFUNDABLE ______Membership Dues Are: $95.00 Before December 31, 2015 $150.00 After January 1, 2016 to July 15, 2016 ______

Please Print Cell Phone ______/______/______

Name ______Phone Number ______/______/______

Address ______City ______Zip ______

Drivers License # ______SS #last four digits______

Birthdate ______E-Mail Address______

Model ______Year ______Engine ______

Cubic in. ______HP - Optional ______In Case of Emergency # ______/______/______

Name of Spouse or Contact Name ______

I hereby state that all above information is accurate and truthful. I understand that any false information that I have given will forfeit my paid dues for the year, and the TTPA will enforce their General Rules of disqualification. This applies for the TTPA pulling season of 2016. Member Sign Name______Date ______Please Circle Class You Will Be Pulling In: 5500 V-8 Hot Rod 8000 Diesel Pro Stock 6200 Pro Street Pickups 6000 Farm 9300 Super Farm 6200 SS Pickup 10 Farm 12,000 Open Farm Hot Diesel Pickups 6500 Modified Tractor Street Legal Pickups 2.5/2.6 Diesel Pickups ______Information for Announcer:

Spouse: ______Number of Years Married: ______

Number of Children and Age: ______

Occupation: ______

Number of Years Pulling, Points Championships and Years: ______

Hobbies: ______

Sponsors: ______Assistant Driver $25.00 ALL MEMBERSHIPS ARE NON-REFUNDABLE This will be paid for each Assistant Driver you have, and must be paid before the Assistant Driver can compete with your vehicle. If not, you will be disqualified.

Name ______Phone Number ______/______/______

Cell Phone # ______/______/______

Address ______City______Zip______

Drivers License # ______SS # last four digits______

Birthdate ______E-Mail Address______

In Case of Emergency - Phone Number & Name ______

______I hereby state that all above information is accurate and truthful. I understand that any false information that I have given will forfeit my paid dues for the year, and the TTPA will enforce their General Rules of disqualification. This applies for the TTPA pulling season of 2016. Assistant Sign Name ______Date______