2022 WOLVERINE PULLERS, INC. MEMBERSHIP FORM
 
Name: _____________________________________Social Security #____________________

Address: ______________________________________________________________________

(City)___________________________________(State) ____________ (Zip) _______________

Phone: _________________________ E-mail________________________________________ 
**Checks to be made out to, if not the same as above name and S.S. # or I.D. # 

Name: ________________________________S.S. # or I.D. #___________________________
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Vehicle Name: ________________________________________________________________

*NTPA Number: ____________________________ Class _____________________________

Additional Vehicle Name: _______________________________________________________

*NTPA Number: ____________________________ Class _____________________________
*Must be an NTPA member ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Associate Dues (non-competing members)                 $35     __________________

Competing Dues- Driver:                                   $70      _________________
                           ($95 after April 1)
Additional Driver                                           $70     __________________        

Name: ____________________________________

Address: __________________________________

Phone: ____________________________________

Vehicle Registration:                                       $60     __________________

Additional Vehicle Registration:                            $60     __________________                                          
(SF competing in SS Combo class $60 per class)

Contingency: to be included in the points race             $100    __________________
**SF competing in SS Combo class, $100 per class, to receive points in both classes

                                                                  NO POINTS ___________

Date Paid____________ Check _______/Cash________ Total Amount ____________

Mail to:  Mindy Trowbridge - Wolverine Pullers, Inc.
         02845 64th Street             
         South Haven, MI 49090
               
         (269) 214—7881
	  Mtrowbridge613@gmail.com