NEW YORK TRACTOR PULLERS ASSOCIATION

							            NEW YORK TRACTOR PULLERS ASSOCIATION
                 2012 MEMBERSHIP APPLICATION
  COMPLETE THE FOLLOWING INFORMATION – PLEASE PRINT

 NAME _________________________________________________________________

 MAILING ______________________________________________________________
 ADDRESS
         ______________________________________________________________

 PHONE ________________________________ EMAIL _________________________

 VEHICLE ____ SUPER STOCK           ____ MODIFIED       ____ TWD

             ____ SUPER FARM        ____ FWD

 VEHICLE NAME _________________________________________________________

 Completion of this form confirms my approval of the use of any photos, videos, and
 information regarding myself and my vehicle by NYTPA for promotional and points fund
 endeavors.


 CHECK TYPE OF MEMBERSHIP:

  ____ Competing Membership (voting rights) Before April 1              $ 75.00

  ____ Competing Membership (voting rights) After April 1               $100.00

  ____ Associate Membership (no voting rights)                          $ 25.00

 It is highly recommended that all crew persons obtain an associate membership. An
 individual must have either a competing membership or associate membership to be
 in the hot pits and track side areas.

 Please complete this form and forward it with your check payable to NYTPA to:

                                 Jessie MacDonald
                           3057 Hopewell Townline Rd.
                            Clifton Springs, NY 14432

For NYTPA Use Only
Date Received ___________________                NYTPA Card # ________________