Type of Membership:  __Member & Tractor    __Member Only    __Tractor Only

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:__________________Year:______
Type of Engines:____________________________Chassis:___________________________________
Vehicle Sponsors:____________________________________________________________________
                           ____________________________________________________________________

Driver Name:________________________________________
Address:____________________________________________
City:________________________State:______Zip:__________ 
Phone:__________________Fax:_________________Email:___________________________________
DOB (if minor)__________________ Age (if minor)_________
Cell Phone:___________________

Membership Dues: 
    # of Drivers                _____X $20.00
    # of Vehicles              _____X $20.00                    Total: $_________

I hereby authorize Shenandoah Valley Tractor Pullers Association Inc. to use the information contained on this form to promote the sport of Garden Tractor Pulling as it deems appropriate, to include magazine/newspaper/newsletter articles and website publishing.

Member Signature and Date:__________________________________________________

Signature of Parent/Legal Guardian
(required for minors 18 & Under):______________________________________________

Please make checks payable to SVTPA
Mail form with payment to:

SVTPA
4551 Lawyer Road
McGaheysville, VA  22840