
One Application Per Driver - Please Print
Send registration and check(s) to: Great Buckeye Tractor Cruise, 2400 Olentangy River Road
Columbus, Ohio 43210
Entries must be received by July 3rd.
Applications are given priority in the order they are received.
Mr/Mrs |
Date of Birth
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First Name or Nickname for Name tag |
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Occupation |
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Nametag for buddy seat rider |
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Mailing Address |
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City |
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Home Phone |
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E-mail |
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Medical Condition/Allergies |
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Physician's Name |
Physician's Phone Number | ||||||||||||||||||||||||||||||||||||||||||||
Tractor Year |
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Tractor Speed |
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I would like to be grouped with: |
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T-Shirt Size |
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Extra Shirt |
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| Extra shirts are $10.00 each (please include this amount with your registration) | |||||||||||||||||||||||||||||||||||||||||||||
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| Do you have a story you'd like to share about your tractor? Please include details on back of printed sheet. | |||||||||||||||||||||||||||||||||||||||||||||
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| In consideration of your acceptance of this entry, I hereby, for myself, my heirs, my executors, administrators, waive all rights and claims for damage I may haveagainst individuals associated with this event, its agencies, representatives, successors and assigns, for any and all injuries suffered by me in the Great Buckeye Tractor Cruise.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 the Great Buckeye Tractor Cruise.I understand that AdVance Broadcasting and Communication, Inc. and/or law enforcement officials reserve the right to limit the number of tractors in the ride in order to control traffic andother administrative tasks. I give my permission for the use of my name and picture in any broadcast, telecast, DVD or print media account of the Great Buckeye Tractor Cruise. | |||||||||||||||||||||||||||||||||||||||||||||
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*Parent or Guardian Signature is also required for participants under 18. I, the undersigned participant (or parent/guardian of the participant if the participant is under the age of 18), acknowledge that I am signing this Authorization and Waiver/Release of Liability in consideration of AdVance Broadcasting and Communication, Inc. permitting me (or my minor child) to participate in the Great Buckeye Tractor Cruise. I acknowledge and fully understand that I (or my minor child) will be engaging in activities that involve risks of serious bodily injury, including permanent disability or death, risk of severe economic and social loss, and other risks either not known to me or not readily foreseeable at this time, which may result not only from my own (or my minor child’Äôs) actions, inactions, or negligence, but also from action, inaction, or negligence of others, the condition of the premises, or the condition of the tractors or any other equipment used. I understand and agree that by signing this Authorization and Waiver/Release of Liability, I am representing that I (or my minor child) am physically able and sufficiently trained to participate in the Great Buckeye Tractor Cruise and that I am assuming full responsibility for all of the foregoing risks and accepting full personal responsibility for any losses, costs, or damages resulting from my (or my minor child’Äôs) participation in the Great Buckeye Tractor Cruise.
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