Applicant’s Name: _________________________________________

Applicant’s Address: _______________________________________

_________________________________________

Telephone Number: ________________________________________

E-mail Address: __________________________________________

_____ $40.00 – Competing Member paid before May 1, 2008

_____ $40.00 – Competing Member paid after May 1, 2008

_____ $20.00 – Social Member paid before May 1, 2008

_____ $20.00 – Social Member paid after May 1, 2008

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Name on Pulling Vehicle: ____________________________________

Year:_____________

Make: _______________________ Model:______________________

Cubic Inches: ________________

Class you are competing in: __________________________________

_______________________________ ________________________

Applicant’s signature & Date

Please send application and money to:

Northwest PA Truck & Tractor Pullers Assoc., Inc.

P. O. Box 145

Jamestown, PA 16134-0145

Please make checks payable to: Northwest Pullers