OFFICIAL PRAIRIE TRACTOR PULLERS SPRING SHOOTOUT ENTRY FORM
March 23 & 24, 2012
AGREEMENT OF RELEASE
1. HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE PRAIRIE TRACTOR PULLERS SPRING SHOOTOUT AS AN ASSOCIATION, INCLUDING ALL ITS CORPORATE ELECTED AND APPOINTED OFFICIALS, ALL MEMBERS OF COMMITTEES, REFEREES AND INSPECTORS, ITS INDIVIDUAL MEMBERS, ITS MEMBER CLUBS, AGENCIES OF GOVERNMENT WHICH CONTROL ESSENTIAL EVENT SITES, FINANCIERS AND FIRM WHICH RENDER ESSENTIAL GRATIS, INCLUDING ALL OFFICERS, AGENTS AND EMPLOYEES OF THE FOREGOING AND VOLUNTEER WORKERS ASSISTING IN SANCTIONED PRAIRE TRACTOR PULLERS SPRING SHOOTOUT EVENT ACTIVITIES, ALL HEREINAFTER REFERRED TO AS “Releases” from or for any and all liability to me, my personal representatives, heirs, next of kin, successors and assigns, for all loss or damage from bodily, or death or damage to property of the undersigned which in any way grows out of or upon alleged breach of any statutory duty or obligation: and
2. HEREBY AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releases and each of them from any loss, liability, damage, or cost the incur due to the presence of the undersigned in or upon the restricted area or in any way competing, officiating, observing, or working for or for any purpose participating in the event and whether caused by the negligence of releases or otherwise; and
3. HEREBY ASSUME FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH, OR PROPERTY DAMAGE due to negligence of releases or otherwise while in or upon the restricted area, and/or while competing, officiating, observing or working for or for any purposes participating in the event; and
4. EXPRESSLY ACKNOWLEDGES AND AGREES THAT THE ACTIVITIES OF THE EVENT ARE DANGEROUS AND INVOLVE THE RISK OF SERIOUS INJURY AND/OR DEATH AND/OR PROPERTY DAMAGE. THE UNDERSIGNED further expressly agrees the foregoing Release Waiver and Indemnity Agreement is intended to be as broad and inclusive as is permitted by the law of the province or State in which the event is conducted, and that if any portion thereof is held invalid, it is agree that the balance shall, notwithstanding, continue in full force and effect.
I HAVE READ THE AGREEMENT OF RELEASE ABOVE AND HAVE SIGNED THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY FOR ALL PRAIRIE TRACTOR PULLERS SPRING SHOOTOUT SANCTIONED EVENTS. IN CONSIDERATION OF PRAIRIE TRACTOR PULLERS SPRING SHOOTOUT PROMOTIONAL EFFORTS ON BEHALF OF THE SPORT, I HEREBY ASSIGN ALL COMMERCIAL PICTURES, MERCHANDISE SALES, AND BROADCAST RIGHTS TO PRAIRIE TRACTOR PULLERS SPRING SHOOTOUT.
_______________________________________________________________________ _____________________________________
SIGNATURE DATE
Driver’s Name: __________________________________________________________Age: _______________________
(please print)
Parent, Guardian, or Owner signature________________________________________Date: ______/______/___________
(parent or guardian signature required if driver is under 18 yrs. of age)
Email address: ______________________________________________________________________________________
Owner’s Name: ________________________________________________Address: ______________________________
City: ____________________________State: ___________Zip: ___________Phone: _____________________________
Tractor Make and Model: _______________________________________ Tractor Name: __________________________
Select 1 (one) class only – a separate entry form per tractor, per class required – ENTRY FORM MAY BE COPIED
_____1050 Stock (Sat)$50 _____1050 Stock V-Twin (Friday)$50 _____1050 Stock Altered (Friday)$50
_____1050 Sport Stock (v-twin) (Sat)$50 _____1050 Super Stock Open (Sat)$50 ____1050 Pro Stock (Friday)$50
_____1250 Super Mod (Friday)$50 ____1350 4 Cylinder (Friday)$50 _____1050 Super Stock(NQS rules)(Sat) $50
____1050 Pro V-Twin (Friday)$50 _____1050 Missouri Super Stock (single)(Friday) $50____1300 Open (Sat)$50
*______1050 Stock Youth (Friday)$25 (NEW)*
Enter Fee $50.00 all classes except Youth (includes driver pit pass & 1 additional)
Total Entry Fees: ___________________
Additional Pit Passes - $10.00 each _____ Additional Pit Passes: _______________
Pit Passes may also be purchased day of event Total Collected: ____________________
Tractor #: _________________________
Make checks payable to: Prairie Tractor Pullers
Mailing address: Prairie Tractor Pullers – Ken Long, 409 Prospect St NE, Blairstown, IA 52209
Pre-Registration Deadline: Postmarked no later than March 5, 2012 to be in pre-event draw.
** Pull Position is determined by random drawing prior to event **
**Any class with 30 or more entries will be split into heats**
** Entries postmarked after 3/5/12, or day of event entries will be charged $10.00 extra fee **
Tech will be open Thursday 3:00pm – 7 :00pm, Friday 7:00am – 1:00pm, & Saturday 7:00am – 9:00am
Pulling Starts 2:00pm on Friday & 10:00am on Saturday
Payback 80% - Top 10 places, Stock Youth Top 5 places
Fuel Specific Gravity Test – MAX .750 & Alcohol – Water Test
Find more information about Prairie Tractor Pullers at - www.Prairiepullers.com
Or call Ken Long – 319-454-6397 nightmarepulling@hotmail.com
Or Jason Johnson – 319-239-5369 jasonj@unverferth.com