MEMBERSHIP APP & SAFETY CERTIFICATION-WW Promotions LLC

MEMBERSHIP APP & SAFETY CERTIFICATION

To sign up for a membership, complete this form and submit the $75 membership fee. Fee can be paid through Paypal (wwpromosllc@gmail.com), by debit card (call 870-404-7782), mailing a check to 30 Bunkerhill Dr, Mtn Home AR 72653, or paying at the first pull.

First Name

Last Name

Date of Birth

Social Security Number

Address

City

State

Zip Code

Phone Number

Year/Model of your truck

Truck Name

What is your shirt size?

By registering for a WW Promotions LLC membership, I certify that I will comply with all necessary safety requirements as described in the General Truck and Contest Rules. This certification will be my acknowledgement that it is my responsibility to ensure that these requirements are met and that they are mandatory for each event that my truck attends. A copy of these requirements and rules can be found on the wwpromotions.com website and will be provided by WW Promotions LLC, upon my request. Failure to follow these safety requirements may result in disqualification; repeated failure to follow them may result in suspension for the remainder of the season.

Additionally, I authorize WW Promotions, and assigns, to utilize names and pictures of my truck and its driver(s). This authorization includes, but is not limited to, sponsors and advertising agencies, whether written, audio, or picture, as needed for promotional purposes.

By signing below, I certify that I have read and agree to all terms as described above and the information provided is true and accurate to the best of my knowledge.

I agree to the terms & conditions as stated above and certify that the person signing below is the same as the person named on this form.

How would you like to pay?

Paypal (wwpromosllc@gmail.com)

Debit card (call 870-404-7782)

Mail to 30 Bunkerhill Dr, Mtn Home AR 72653 (checks made payable to WW Promotions)

Pay at pull

Signature

Date of Signature