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OFFICIAL PRAIRIETRACTOR PULLERS SPRING SHOOTOUT ENTRY FORM

March 25 & 26, 2011

AGREEMENT OF RELEASE

HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE PRAIRIETRACTOR PULLERS SPRING SHOOTOUT AS AN ASSOCIATION, INCLUDING ALL ITS CORPORATEELECTED AND APPOINTED OFFICIALS, ALL MEMBERS OF COMMITTEES, REFEREES ANDINSPECTORS, ITS INDIVIDUAL MEMBERS, ITS MEMBER CLUBS, AGENCIES OF GOVERNMENTWHICH CONTROL ESSENTIAL EVENT SITES, FINANCIERS AND FIRM WHICH RENDER ESSENTIALGRATIS, INCLUDING ALL OFFICERS, AGENTS AND EMPLOYEES OF THE FOREGOING ANDVOLUNTEER WORKERS ASSISTING IN SANCTIONED PRAIRE TRACTOR PULLERS SPRINGSHOOTOUT EVENT ACTIVITIES, ALL HEREINAFTER REFERRED TO AS “Releases” from orfor any and all liability to me, my personal representatives, heirs, next ofkin, successors and assigns, for all loss or damage from bodily, or death ordamage to property of the undersigned which in any way grows out of or uponalleged breach of any statutory duty or obligation: and

HEREBY AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releases andeach of them from any loss, liability, damage, or cost the incur due to thepresence of the undersigned in or upon the restricted area or in any waycompeting, officiating, observing, or working for or for any purpose participatingin the event and whether caused by the negligence of releases or otherwise; and

HEREBY ASSUME FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH,OR PROPERTY DAMAGE due to negligence of releases or otherwise while in or uponthe restricted area, and/or while competing, officiating, observing or workingfor or for any purposes participating in the event; and

EXPRESSLY ACKNOWLEDGES AND AGREES THAT THE ACTIVITIES OF THE EVENT AREDANGEROUS AND INVOLVE THE RISK OF SERIOUS INJURY AND/OR DEATH AND/OR PROPERTYDAMAGE. THE UNDERSIGNED further expressly agrees the foregoing Release Waiverand Indemnity Agreement is intended to be as broad and inclusive as ispermitted 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 balanceshall, notwithstanding, continue in full force and effect.

I HAVE READ THE AGREEMENT OF RELEASE ABOVE AND HAVESIGNED THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY FOR ALL PRAIRIETRACTOR PULLERS SPRING SHOOTOUT SANCTIONED EVENTS. IN CONSIDERATION OF PRAIRIETRACTOR PULLERS SPRING SHOOTOUT PROMOTIONAL EFFORTS ON BEHALF OF THE SPORT, IHEREBY ASSIGN ALL COMMERCIAL PICTURES, MERCHANDISE SALES, AND BROADCAST RIGHTSTO PRAIRIE TRACTOR PULLERS SPRING SHOOTOUT.

Signature_______________________________________________________________________                                       Date_____________________________________

 
Driver’s Name:__________________________________________________________Age:_______________________

(please print)

Parent, Guardian, or Ownersignature________________________________________Date:______/______/___________

(parent or guardian signaturerequired 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 classrequired – ENTRY FORM MAY BE COPIED

_____1050Stock  (Sat)$40      _____1050 StockV-Twin (Friday)$50   _____1050 Stock Altered(Friday) $50

_____1050Sport Stock (v-twin) (Sat)$50   _____1050 Super Stock Open (Sat)$50 ____1050 Pro Stock(Friday) $50

_____1250Super Mod(Friday)$50    ____13504 Cylinder (Friday)$50    _____1050 Super Stock(NQSrules)(Sat) $50

_____1050 Pro V-Twin (Friday)$50 ____1050Missouri Super Stock (single)(Friday) $50  _____1300 Open(Sat) $50

Entry Fee: $50.00 – all classes except Stockclass $40.00                                 TotalEntry Fees: _________________

(includes drivers pit pass & one additional)

Additional Pit Passes -$10.00 each                                                 _____      Additional Pit Passes: _______________

Pit Passes may also bepurchased day of event                                              TotalCollected: ____________________

Tractor #: _________________________

Make checks payable to: PrairieTractor Pullers

Mailing address: PrairieTractor Pullers – Ken Long, 409Prospect St NE, Blairstown, IA 52209

Pre-Registration Deadline:Postmarked no later than March 5, 2011 to be in pre-event draw.

** Pull Position is determined by random drawing prior toevent **

**Any class with 30 or more entries will be split intoheats**

** Entries postmarked after3/5/11, or day of event entries will be charged $10.00 extra fee and will pullat end of class order **

Tech will be open Thursday3:00pm – 7 :00pm, Friday 7:00am – 1:00pm, & Saturday 7:00am – 9:00am

Pulling Starts 2:00pm on Friday & 10:00am onSaturday

Payback 80% - Top 10 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