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
First Name or Nickname for Name tag
Occupation
Nametag for buddy seat rider
Mailing Address
City
State
Zip
Home Phone
E-mail
Medical Condition/Allergies
Physician's Name
 Physician's Phone Number
Tractor Year
Tractor Speed
 
10 mph
11 mph
12 mph
13 mph
14 mph
15 mph
over 15 mph
I would like to be grouped with:
T-Shirt Size
Small Medium Large XL XXL XXXL
Extra Shirt
Small Medium Large XL XXL XXXL
  Extra shirts are $10.00 each (please include this amount with your registration)
 
 
Would you like to reserve a copy of the 2008 Great Buckeye Tractor Cruise DVD?
Yes No
 
 
Do you have a story you'd like to share about your tractor? Please include details on back of printed sheet.
 
 
 
 
FEE
 Your Charges
 
   
REGISTRATION
$30
 $30
 
   
2008 DVD (each)
$20
  
 
   
Extra T-shirt (each)
$10
  
 
   
Extra Lunch (each)
$10
  
       
   
TOTAL:
  
 
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.
 
 
 
X Signature
 
*Parent or Guardian Signature is also required for participants under 18.