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 (you can adjust this quantity at checkout)
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.
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.
Electronic Signature
X Signature
*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.           I understand and agree that by signing this Authorization and Waiver/Release of Liability, I am agreeing to release, discharge, covenant not to sue, indemnify and hold harmless AdVance Broadcasting and Communication, Inc. and its owners, directors, officers, agents, employees, and associated personnel from any and all liability, claims, demands, losses, injuries, damages, or costs, including attorney fees, associated with or arising from my (or my minor child’Äôs) participation in any activities at the Great Buckeye Tractor Cruise, which participation I hereby authorize.  I understand that this Authorization and Waiver/Release of Liability will be binding on me, my spouse, my heirs, my personal representatives, my assigns, my children and any guardian ad litem for said children.          I acknowledge that I have read this Authorization and Waiver/Release of Liability and that I understand the words and language in it.  I understand that I am giving up substantial rights by signing this Authorization and Waiver/Release of Liability and I sign below voluntarily.  I intend by my signature that this Authorization and Waiver/Release of Liability be a complete and unconditional release of all liability to the greatest extent allowed by law.  I agree that if any portion of this Authorization and Waiver/Release of Liability is held to be invalid the balance, notwithstanding, shall continue in full force and effect.  This Authorization and Waiver/Release of Liability shall be governed by all purposes by Ohio law, without regard to the law of conflicts of law.                         I understand that AdVance Broadcasting and Communication, Inc. and law enforcement officials reserve the right to limit the number of participants in the event for any reason (including limiting the number of tractors in the ride in order to control traffic).  I give my permission for the use of my (or my minor child’Äôs) name and picture in any broadcast, telecast, DVD or print media account of the Great Buckeye Tractor Cruise.