Member Number # ____________
Membership Application
Name: ___________________________________DOB___________
Address: ________________________________________________
________________________________________________________
Phone: __________________________________________________
Cell: ____________________________________________________
Email: ___________________________________________________
Drivers License No#________________________________________
Emergency Contact Information: ______________________________
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For Members under the age of 18,
I, ________________________________________Member#________
am the parent or guardian of above registered child and a dues paying member of the Central Jersey Tractor Pullers Association. As the parent or guardian of child listed above I, fully understand that Central Jersey Tractor Pullers Association is not liable for injuries to the child.
__________________________________________________________
Signature of Parent or Guardian
Rev 2/14
