YEAR 2023 MICHINDOH ASSOCIATION MEMBERSHIP APPLICATION

MICHINDOH Truck #                                   New Member yes / no
___6200lb 2WD Super Stock, ___5200lb 2WD Pro Street, ___8000lb Hot Street Diesel Truck – ___4x4 6200lb 4X4 Altered Truck,___ 5,700lb Michindoh Modifieds,___ 6000lb 4X4 Stateline Pro Street

NAME: _______________________PHONE#________________________________
ADDRESS__________________________________________________________ CITY_________________________________STATE__IN_____ZIP_______________   
E-MAIL_________________________________________________________________

 ANNOUNCER INFORMATION (Print or Type Legibly)

TRUCK NAME: _______________________________________________

ENGINE SIZE: _________________TRUCK MAKE: YEAR:_________________________

ACCOMPLISHMENTS-SPONSORS-SPECIAL THANKS ETC:

_____________________________________________________

AGREEMENT

(REVISED 3/12/2023)

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, ¼” 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 ¼” 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.

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                         MEMBER SIGNATURE                                                                                                 DATE

INFORMATION BELOW TO BE FILLED OUT BY SECRETARY

---------------------------------------------------------------------------- PREVIOUS YEAR POINTS WINNER- YES OR NO (Circle one)

CASH/CHECK $____________FULL- MEMBERSHIP

FEE__$60.00_________early$50.00________HALF__30.00_______

RECEIVED BY SECRETARY                                         ________________________DATE___________________