YEAR___2017___MICHINDOH ASSOCIATION MEMBERSHIP APPLICATION

MICHINDOH Truck # New Member yes / no

6200# 2 WD Super Stock ___6200# 4WD Altered ____ Stateline Pro Street 4X4___

5800# 2WD Gas___ 7800# 4WD 2.5 Diesel___

5500# Modified Rail___ 9500# Hot Farm___ 8500# Pro Farm ___

NAME: ______________________________PHONE#___________________________

ADDRESS______________________________________________________________

CITY________________________________STATE__________ZIP________________

E-MAIL_________________________________________________________________

ANNOUNCER INFORMATION (Print or Type Legibly)

TRUCK NAME: ____________________________________________________________________

ENGINE SIZE: ____________________TRUCK MAKE: YEAR:_____________________

ACCOMPLISHMENTS-SPONSORS-SPECIAL THANKS ETC: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

AGREEMENT

(REVISED 11/20/2016)

As a member of the MICHINDOH Association, I agree to abide by all rules of MICHINDOH set forth in the current year rule book and to adhere to the decisions of the tech officials at all times. If a legitimate complaint occurs, I will follow the steps outlined in the protest procedure to settle the matter. I also, agree not to enter into any litigation against MICHINDOH, its officers, Board of Directors or Tech Officials.

NOTE: CLUTCHES & FLYWHEELS---1) Vehicle must have one piece, Hydro-form bell housing on straight shift. If any modifications are made, modified area must be ground smooth inside and out. 2) All VEHICLES using a clutch and flywheel assembly will run a full block saver plate, either aluminum or 1/8 steel required in all classes. ALL flywheels must be steel or aluminum. NO cast stock flywheels allowed. Each vehicle owner will sign a waiver on the membership card stating they are running a SFI approved flywheel. 3) Automatics required to run a one-piece SFI SPEC 4.1 6-buckle full-length transmission blanket or SFI approved shield in all classes.

_____________________________________________________ ________________________

MEMBER SIGNATURE DATE

INFORMATION BELOW TO BE FILLED OUT BY SECRETARY

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PREVIOUS YEAR POINTS WINNER- YES OR NO

CASH/CHECK $____________FULL- MEMBERSHIP FEE____________HALF_________

RECEIVED BY SECRETARY DATE