Badger State Dirt Flingers

BADGER STATE DIRT FLINGERS
2010 MEMBERSHIP APPLICATION & LIABILITY RELEASE FORM

Owner Information
Owners Name:
Age:
Number of years pulling:
Address:
City:
State:
Zip:
Primary Phone Number (123-456-7890):
Secondary Phone Number (123-456-7890):
Driver Information
Drivers Name:
Age:
Number of years pulling:
Address:
City:
State:
Zip:
Primary Phone Number (123-456-7890):
Secondary Phone Number (123-456-7890):
Vehicle Information
Vehicle Description:

Classes:	950# Stock Altered Garden Tractors 1050# Stock Altered Garden Tractors 1050# Light Super Mod 1100# Stock 4x4 1100# Light Super 1200# Stock 4x4 1250# Heavy Super Mod 1350# Heavy Super 1400# Open Cylinder 1450# Unlimited Outlaws 1600# Unlimited Outlaws 1850# Mini Rods - 420cc Limit 1900# Minis
Tractor Name:
Tractor #:
Tractor Make & Model:
Engine Make & Size:
Other Tractor Info (fuel, modifications):

Misc. Info (Sponsors, Awards, Championships):

Dues Calculator
Membership: $35.00 * machine/s
Non-Puller Membership: $10.00 * person/s