YEAR___201
7___MICHINDOH ASSOCIATION MEMBERSHIP APPLICATIONMICHINDOH 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, 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.
_____________________________________________________ ________________________
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