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Carroll County Farm Bureau Tractor Drive Driver Application Tuesday, August 5, 2008 Personal Information: (Please Print Clearly) Name: __________________________________________________________________ Address: ______________________________________________________________ City: ____________________________ State: _________ Zip: _________________ Home Phone: _____________________ Cell Phone: ______________________ Clearly Print How Your Name Is To Appear On The Name Tag:______________________ Email Address: ________________________________________________________ Tractor Information: Tractor Make: ___________________ Model: ________________ Year:______ Road Speed of Tractor: ____________ (min 10 mph) I will be leaving my tractor at the fair overnight _________ Driver Safety Pledge I, ________________________, Pledge that by signing the safety pledge for the Carroll County Tractor Ride 2008 I agree to abide by all the rules set forth and that my tractor and I will meet all necessary requirements. I have a valid driver’s license. I have insurance on my tractor which is considered a motor vehicle while driving on Illinois roads. (proof of insurance required) I will follow all traffic laws. I will not carry riders along on my tractor. I will stay with assigned group. I will not pull anything with my tractor during the ride. I will have an smv sign posted on my tractor I will follow the instructions of the group leader and sponsoring organizations. I will not pass other tractors on the ride unless instructed. I will not consume any alcohol while driving my tractor. I will maintain a safe yet close distance between tractors. Signature: _________________________________________ Date: _______________ Please mail this form with a check in the amount of $35 payable to the Carroll County Farm Bureau to: 811 South Clay Street Mount Carroll, IL 61053 Registration is limited to the first 75 tractors. Questions? Contact the Carroll County Farm Bureau at 815-244-3001.
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