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2008 WTPA MEMBERSHIP APPLICATION

NAME: _______________________________________ DATE: __________________

ADDRESS: ____________________________________ CASH/CHECK: __________

CITY: _______________________ STATE: ___________ ZIP: ___________________

PHONE: Home- ____________________ Work/Cell- ____________________

E-MAIL ADDRESS (optional): _____________________________________________

All Checks to be issued PAYABLE TO: _______________________________________

SOCIAL SECURITY #: __________________ FED ID #: _____________________

COMPETING MEMBERSHIP ____________ $50.00 to Dec. 31, $70.00 after Jan. 1

ASSOCIATE MEMBERSHIP _____________ $25.00 to Dec. 31, $35.00 after Jan. 1

ONE TIME HOOK FEE _________________ $20.00 per hook at each event

CLASSES AND VEHICLE INFORMATION

_____ Super Stock _____ Super Farm _____ Modified _____ Four Wheel Drive

_____ Two Wheel Drive _____ Super Stock Four Wheel Drive _____ Mini-Rod

Chassis/Make/Year/Model ________________ Engine/Model __________________________

Vehicle Name __________________________ Team Name ____________________________

Jacket Size _____________________________

Please make checks payable to: Wisconsin Tractor Pullers Association (WTPA)
Send to:
Tiffany Faust
393 Taft Street
Fond du Lac, WI 54935