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Tractorcade 2012

Application rev 12/11

The Great Eastern Iowa Tractorcade 2012 Primary Driver Application


Ride Dates: June 10-13, 2012

(Only ONE Applicant per Form Please)

PERSONAL INFORMATION: (Complete ALL information and print clearly) Name ______________________________________________________________ Address_____________________________________________________________ City ________________________________________________ State_____________ ZIP_____________ Phone #: Home ____________________ Work _____________________ Cell ______________________ Email address___________________________________________________ Clearly print how YOUR name is to appear on the name badge: __________________________________________ Have you been a Primary Driver in Tractorcade in the past? Yes Will you bring a support team (people not driving tractors)? Yes completed for each driver) First and last name of your Secondary Driver: _________________________________________________ I am interested in being a (please check all that apply) Group Leader Emergency Medical Contact Sunday Volunteer Physician's Name & Phone # and any medical issues we should know about ______________________________________________________________________________________ ______________________________________________________________________ In case of emergency, please notify: Name: ____________________________ Phone: ________________ TRACTOR INFORMATION Tractor Make __________________________ Model__________________________ Year____________ What type of fuel does your tractor require? Gas LP Will you use a buddy seat? Yes Diesel Other____________________ No No If yes...How Many Years (2012 will be the 13th year): _________ Will you have one or more Second Drivers? Yes No (If Yes, Second Driver applications MUST be

No (If yes, Buddy Seat Application must be submitted)

Tractorcade 2012

Application rev 12/11

Preferred traveling speed ­ tractor speed is used to determine group placement. CHOOSE WHICH GROUP YOU WOULD LIKE TO BE IN CAREFULLY! Remember this is how fast you want to go...not how fast you can go. Please indicate your first and second group preference. We will accommodate you as best as we can. __ Group 1- 10 MPH __ Group 4- 11-12 MPH __ Group 2- 11-12 MPH __ Group 5- 13-14 MPH ___ Group 7- 15+ MPH

OPTIONAL: I'd like to be in a group with (name) ________________________________ (If several drivers want to travel in the same group please choose ONE name that all members of the group will put in this blank. We will try to accommodate requests as best we can.)

__ Group 3- 11-12 MPH __ Group 6- 13-14 MPH

Lead Driver Safety Pledge

I, ____________________________________, hereby pledge to hold safety as the highest priority on The Great Eastern Iowa Tractorcade 2012. The safety of my fellow riders and the public traveling on the route is of the utmost importance. I pledge to obey the following rules: To hold a valid drivers license (We will check your license during registration!) To follow all traffic laws To not carry riders except in an approved buddy seat To stay with my assigned group To depart during my assigned group's designated time To not have bicycle companions To not pull campers or trailers. Small carts are permitted. 6 ft max (hitch to tail) Length limit will be enforced To post SMV sign To follow the designated route To abide by the decisions of the Ride Management Team, based on the National Weather Service, in the event of inclement weather. To utilize a rearview mirror when possible To stay on my tractor at all times until we have reached our destination, even if tractors come to a complete stop on the road. REARVIEW MIRRORS ARE REQUIRED

I understand violating these rules will result in the denial of all future applications. Repetitive violators will be asked to leave the ride per the Ride Management Team. Signature__________________________________________ Date: _____________________________

In consideration of your acceptance of this entry, I hereby, for myself, my heirs, my executors, administrators, waive any and all rights and claims for damage I may have against individuals associated with this event, its agencies, representatives, successors and assigns, for any and all injuries suffered by me in said event. I attest and verify that I have full knowledge of the risks involved in this event and am physically able and sufficiently trained to participate in this event. I understand WMT Radio reserves the right to limit the number of tractors in the ride in order to control traffic and other administrative tasks. I give my permission for the free use of my name and picture in any broadcast, telecast, or print media account of this event.

Signature _____________________________________________ Date___________________________

Tractorcade 2012

Application rev 12/11

T-SHIRT INFORMATION: T-shirt size: Small XL Medium XXL ($5 additional charge) Large XXXL ($5 additional charge)

Additional t-shirts may be purchased for $10 each (sizes XXL and larger $15 each) Number of additional shirts________________ Sizes _______________________

ONE registrant per form. Applications are confirmed by postmark or received date (when submitted in person). Please note that applications submitted either in person or by mail on the announcement date does not guarantee a spot on the ride. Please include non-refundable application fee of $135.00 with form. Make checks payable to WMT Radio. Applications which cannot be accepted because the available slots are filled will be held and placed on a waiting list in case of cancellations, but your application fee will be returned to you immediately. Confirmation letters will be sent to accepted applicants within 4-6 weeks following the close of registration.

Fees enclosed: Ride Application: *XXL/larger t-shirt (extra $5 each) *Additional t-shirts ($10/$15 each) Second Driver(s): ($60 each) *2012 Tractorcade DVD ($15 each) Total Amount Enclosed *optional fees $135.00 _______ _______ _______ _______ _______

Mail Application to Tractorcade - WMT Radio 600 Old Marion Road NE Cedar Rapids, IA 52402

Applications by mail must be postmarked on or after the date of the route announcement (January 11, 2012). Applications submitted in person to the WMT studios or postmarked prior to the announcement date will not be accepted. Final Application deadline Febrary 1, 2012

PLEASE FILL OUT MEAL INFORMATION! Do you plan on eating meals along the route? Yes Maybe No If you checked yes or maybe, please indicate which meals you plan to eat with the group and number of people you're expecting to eat with you (include any support/family members but not other drivers). This is NOT binding! It just gives us a chance to get a better idea of the number of people we will likely serve. If you do not intend to eat one or more of these meals with the group, please check NO above and leave the section below BLANK. SUNDAY MONDAY TUESDAY WEDNESDAY #_____Lunch #_____ Breakfast #_____ Breakfast #_____ Breakfast #_____Dinner #_____Lunch #_____Lunch #_____Lunch

#_____Dinner #_____Dinner

Office Use Only Date Received____________ Taken By: _______________________ Check#____________ Amount_______________ Remitter: _______________________________________ For Applicant: __________________________________________


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