Hot Rod Garden Tractor and Mini Truck Pullers Association

Membership Registration Form


This will register an individual or entire family for full membership and participation at all HRGTPA pulls and meetings. Indicate whether the registration is for an individual or an entire family (parent(s) or child/children under the age of 19 and still living at home).

FREE Puller Membership for 2016! You do not need to be a paid member to participate with the HRGTPA at any event! However, being the HRGTPA is not-for-profit professional pulling organization, monetary contributions and donations would be appreciated to help cover pulling insurance costs and various other expenses for operations of the club.

Name(s):________________________________________________________________________________________________________

Address:____________________________________________City:_______________________________State_________ Zip:____________

Home Phone:_____________________________________________Cell Phone:_______________________________________________

Emergency Contact:________________________________________________________________________________________________

Email Address(es):_________________________________________________________________________________________________
 

Member/Puller Name______________________________________

Puller Age_______________________________________________

Tractor Name____________________________________________

Tractor Name____________________________________________

Class___________________________________________________


Member/Puller Name______________________________________

Puller Age_______________________________________________

Tractor Name____________________________________________

Tractor Name____________________________________________

Class___________________________________________________

 

Member/Puller Name______________________________________

Puller Age_______________________________________________

Tractor Name____________________________________________

Tractor Name____________________________________________

Class___________________________________________________


Member/Puller Name______________________________________

Puller Age_______________________________________________

Tractor Name____________________________________________

Tractor Name____________________________________________

Class___________________________________________________

WAIVER OF CONSENT - FOR MINORS IN COMPETITION

I,____________________________ give permission for ____________________________ to compete in the ______ (year) HRGTPA pulling season.

Minor Signature__________________________________________ Parental Signature_________________________________________

Please read, print out and fill out these two forms also: RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT | MINOR RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT. (Requires Adobe Acrobat Reader and use Google Chrome for a faster download.) Please return all three completed forms with payment to: Brian Miller, 1501 W. Old Plank Rd., Columbia, MO 65203-9136 | Phone: 1-573-256-0313 (home/shop) | 1-573-881-7229 (cell) | Fax: 1-573-449-7347 | E-mail: pullingtractor@aol.com | Web site: http://hrgtpa.com Please return the original signed contract to HRGTPA and make a copy for your records. Print This Page | Go to HRGTPA Home Page | Close This Web Page.