This will register an individual or family of pullers for one year of membership and participation at all MMTMRPA meetings and pulling events. MMTMRPA yearly membership dues is $100.00 per individual, or $75.00 per family. And being the MMTMRPA is not-for-profit organization, monetary contributions and donations would be appreciated to help cover insurance costs and various other operating expenses of the club. Please read, print out and fill out this form. Please make checks payable to MMTMRPA. If you have any questions or if you would like to participate with the MMTMRPA, please contact: Brian Miller, 12091 N. Route B, Hallsville, Missouri 65255 | Phone: 1-573-881-7229 (cell) | E-mail: pullingtractor@aol.com | President: Vice President: (To be determined at future meeting.) | Board Members: (To be determined at future meeting.) | Secretary/Treasurer: (To be determined at future meeting.) | Sled Operator: Martin Wolbeck. Please send us an email so we can put your name on our mailing list.
Name (Owner of Compact Truck or Mini Rod):__________________________________________________________________________
Address:____________________________________________City:_______________________________State_________ Zip:____________
Home Phone:_____________________________________________Cell Phone:_______________________________________________
Emergency Contact:________________________________________________________________________________________________
Email Address(es):_________________________________________________________________________________________________
| Please check one: Compact Truck [_] Mini Rod [_]
Driver/Puller Name:____________________________________________ Name of Pulling Vehicle:________________________________________ Year, Make, Model & Engine Size:________________________________ Class:_______________________________________________________ |
Please check one: Compact Truck [_] Mini Rod [_]
Driver/Puller Name:____________________________________________ Name of Pulling Vehicle:________________________________________ Year, Make, Model & Engine Size:________________________________ Class:_______________________________________________________ |
| Please check one: Compact Truck [_] Mini Rod [_]
Driver/Puller Name:____________________________________________ Name of Pulling Vehicle:________________________________________ Year, Make, Model & Engine Size:________________________________ Class:_______________________________________________________ |
Please check one: Compact Truck [_] Mini Rod [_]
Driver/Puller Name:____________________________________________ Name of Pulling Vehicle:________________________________________ Year, Make, Model & Engine Size:________________________________ Class:_______________________________________________________ |
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