Member Group: __ Shenandoah Valley Tractor Pullers              __ Member Group ______________________

Class:  __ 900 lb Stock Jr. Adult                                   __ 1100 lb Sportsman Super Modified
           __ 900 lb Stock Adult                                        __ 1200 lb Pro-Sportsman Super Modified
           __ 1000 lb Stock                                               __ 1400 lb Pro-Eliminator Super Modified
           __ 1050 lb Stock                                               __ 1600 lb Pro-Sportsman Mini-Rod
           __ 1100 lb Stock-Altered                                   __ 1850 lb Eliminator Mini-Rod
           __ 1050 lb Pro-Stock

Vehicle Name:_____________________Brand of Vehicle:_____________Type of Engine_______________

Driver #1 Name:_________________________________
Address:_______________________________________
City:___________________State:_______Zip:__________
Phone:__________________Fax:________________Email:______________________________________

Driver #2 Name:_________________________________
Address:_______________________________________
City:___________________State:_______Zip:_________
Phone:__________________Fax:________________Email:______________________________________

Event and Points Check Information
Event Checks and points check get made out to__________________________and the
SS# or FID is_____________________
If event checks gets made out to who is driving please provide the additional driver
Name:_________________________ and SS#_________________________

Deadline on/or before February 15, 2012
    # of Drivers                ______X $50.00
    # of Vehicles              ______X $50.00            Total $ _________

After February 15, 2012
    # of Drivers                ______X $75.00
    # of Vehicles              ______X $75.00            Total$ __________

Information given for competition license will be embossed on membership card and the SS#/FID will be used for tax purposes.  All of the above information is required for processing of the competition license.  Members will receive a rule book, decals, patches and membership card via US mail.  For an event purse or points check to be paid a vehicle must display all decals in a visible location, not under fenders or on the frame.

Make check payable to SVTPA.  Mail form and payment to:
SVTPA
4551 Lawyer Road
McGaheysville, VA  22840