OFFICIAL PRAIRIE TRACTOR PULLERS SPRING SHOOTOUT ENTRY
FORM
March 19 & 20, 2021
AGREEMENT OF RELEASE
1.
HEREBY RELEASE,
WAIVE, DISCHARGE AND COVENANT NOT TO SUE PRAIRIE TRACTOR PULLERS SPRING
SHOOTOUT AS AN ASSOCIATION, INCLUDING ALL ITS CORPORATE ELECTED AND APPOINTED
OFFICIALS, ALL MEMBERS OF COMMITTEES, REFEREES AND INSPECTORS, ITS INDIVIDUAL
MEMBERS, ITS MEMBER CLUBS, AGENCIES OF GOVERNMENT WHICH CONTROL ESSENTIAL EVENT
SITES, FINANCIERS AND FIRM WHICH RENDER ESSENTIAL GRATIS, INCLUDING ALL
OFFICERS, AGENTS AND EMPLOYEES OF THE FOREGOING AND VOLUNTEER WORKERS ASSISTING
IN SANCTIONED PRAIRE TRACTOR PULLERS SPRING SHOOTOUT EVENT ACTIVITIES, ALL
HEREINAFTER REFERRED TO AS “Releases” from or for any and all liability to me,
my personal representatives, heirs, next of kin, successors and assigns, for
all loss or damage from bodily, or death or damage to property of the
undersigned which in any way grows out of or upon alleged breach of any
statutory duty or obligation: and
2.
HEREBY AGREE TO
INDEMNIFY AND SAVE AND HOLD HARMLESS the releases and each of them from any
loss, liability, damage, or cost the incur due to the presence of the
undersigned in or upon the restricted area or in any way competing,
officiating, observing, or working for or for any purpose participating in the
event and whether caused by the negligence of releases or otherwise; and
3.
HEREBY ASSUME FULL
RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH, OR PROPERTY DAMAGE due to
negligence of releases or otherwise while in or upon the restricted area,
and/or while competing, officiating, observing or working for or for any
purposes participating in the event; and
4.
EXPRESSLY
ACKNOWLEDGES AND AGREES THAT THE ACTIVITIES OF THE EVENT ARE DANGEROUS AND
INVOLVE THE RISK OF SERIOUS INJURY AND/OR DEATH AND/OR PROPERTY DAMAGE. THE
UNDERSIGNED further expressly agrees the foregoing Release Waiver and Indemnity
Agreement is intended to be as broad and inclusive as is permitted by the law
of the province or State in which the event is conducted, and that if any portion
thereof is held invalid, it is agree that the balance shall, notwithstanding,
continue in full force and effect.
I HAVE READ THE AGREEMENT
OF RELEASE ABOVE AND HAVE SIGNED THE RELEASE AND WAIVER OF LIABILITY AND
INDEMNITY FOR ALL PRAIRIE TRACTOR PULLERS SPRING SHOOTOUT SANCTIONED EVENTS. IN
CONSIDERATION OF PRAIRIE TRACTOR PULLERS SPRING SHOOTOUT PROMOTIONAL EFFORTS ON
BEHALF OF THE SPORT, I HEREBY ASSIGN ALL COMMERCIAL PICTURES, MERCHANDISE
SALES, AND BROADCAST RIGHTS TO PRAIRIE TRACTOR PULLERS SPRING SHOOTOUT.
_______________________________________________________________________ _____________________________________
SIGNATURE – MUST SIGN DATE
Driver’s Name:
__________________________________________________________Age:
_______________________
(please print)
Parent, Guardian, or Owner
signature________________________________________Date:
______/______/___________
(parent or guardian signature
required if driver is under 18 yrs. of age)
Email address:
______________________________________________________________________________________
Owner’s Name:
________________________________________________Address:
______________________________
City:
____________________________State: ___________Zip: ___________Phone:
_____________________________
Tractor Make and Model:
_______________________________________ Tractor Name:
__________________________
Engine Brand
__________________________
Single_____ Flat Twin ______ V-Twin ________ Must select one!
(excluding
super mod, and open classes)
Select 1 (one)
class only – a separate entry form per tractor, per class required – ENTRY FORM
MAY BE COPIED
_____1050
Stock (Sat)$50 _____1050
Stock V-Twin
(Friday)$50 _____1050 Stock Altered (Friday)$50 _____30 Cube (Sat)(NQS Rules)$50
(single & flat twin only)
_____1050
Sport Stock (v-twin) (Sat)$50 _____1050 Super Stock Open (Sat)$50 ____1050 P.S.T. (NQS Rules) (Friday)$50
_____1250
Super Mod
(Friday)$50 _____1350 .Open (Friday)$50 _____1050 Super
Stock(NQS rules)(Sat) $50
______1050 Pro V-Twin( NQS rules) (Friday)$50 ______ 1050 MO Super Stock (single)(Friday) $5
______1350 Open (Sat)$50 ________ 1250 Sup Mod-800 CC (sat)$50
_____1050 Stock Youth (Friday)$25 Enter Fee $50.00 all classes except Youth (includes driver pit pass & 1 additional)
Schedule is subject to change Total
Entry Fees: ___________________
Additional Pit Passes -
$10.00 each _____ Additional Pit Passes: _______________
Pit Passes may also be
purchased day of event Total
Collected: ____________________
Tractor #: _________________________
Make checks payable to: Prairie
Tractor Pullers
Mailing address: Prairie
Tractor Pullers – 409 Prospect St NE,
Blairstown, IA 52209
Pre-Registration Deadline:
Postmarked no later than March 1, 2021 to be in pre-event draw.
SAME LOCATION – NEW NAME -Hippodrome
– Waterloo, Iowa
** Pull position is determined by
random drawing prior to event**
**Any class with 30 or more entries will be split into heats** ** Entries postmarked after 3/1/2021 or day
of event entries will be charged $10.00 extra fee **
**Tech will be open Thursday 3:00pm – 7 :00pm, Friday
7:00am – 10:00am, & Saturday 7:00am – 9:00am **Pulling Starts 11:00am on Friday & 10:00am on Saturday
**Please check
all rules**. **Fuel
Specific Gravity Test – MAX .750 & Alcohol – Water Test
Find more information about
Prairie Tractor Pullers at - www.Prairiepullers.com
Or call Scott Long – 319-721-6239
– Kristi Wright 319-721-4979 kristil@netins.net
Jason Johnson –
319-239-5369 jasonjohnson380@gmail.com
Jim Malmberg – 319-530-3996
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