PPL license form for 3.0

[Dennis Perry]

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Pulling Position #
2011 Pro Pulling Competition License
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Member Group: *​● Midwest Region
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Class: *​● Pro Street Diesel Trucks (3.0) ​
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Vehicle Name:​ *​ Brand of Vehicle:​Type of Engines:​
Primary Driver Name_______________________________________________________
Address_____________________________________________________________City_______________________________ *
State________ * Zip________________Phone____________________ *Fax___________________ Email_________________________
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Event and Points check Information
Event Checks and points check get made out to ​ and the SS# or FID is​______​__
If event checks gets made out to who is driving please provide the additional driver Name______________________________________ and SS#​
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Regular Membership ​​
​$100 per PPL Driver ​$_______Total for regular membership​$100 per PPL Vehicle​$ 30.00 *Hook Fee​
​$_______ Event Total​​
Form must be signed below
In Consideration of the Lucas Oil Pro Pulling League promotional efforts on behalf of the sport, I hereby assign all commercial pictures, merchandise sales and broadcast right to the Lucas Oil Pro Pulling League
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Applicants Signature​Date
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Make Check Payable to: *Pro Pulling League; PO Box 287; Brownstown, IN *47220
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Drivers Name:_________________________________________
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City, State:____________________________________________