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2022 Midwest Winter Nationals 10,000 Pro Farm Registration Form
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1
Terms and Conditions
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Please read over the rules and regulations for your class by clicking rules and regulations. Once you have read over the rules for your class please check the box that you agree to continue the form. By clicking the box, you agree to all the rules and regulations for the 2022 Midwest Winter Nationals Each puller gets 2 all weekend pit passes. Add any extra pit pass to your cart to receive them in advance. Due to a time constraint set by the building owners each day, we have a predetermined number for each class. Once the class is FULL, registration will close. We will have a standby list and we will make adjustments if numbers for some classes are not met. If you are entering multiples vehicles you will need to register each vehicle separately. If you are entering in multiple classes you will need to enter each class separately. Registration Schedule:
Early Bird Price thru October 6th = $185
October 7th thru 27th = $210
October 28th thru Nov. 17th = $235
After Nov. 18th = $250
Thanks! Whatssmokin Promotion Team
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2
Registration Name
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First Name
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3
Address
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Street Address
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Bolivia
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Botswana
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Brunei
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Burkina Faso
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Cambodia
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Canada
Cape Verde
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China
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Malawi
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Marshall Islands
Martinique
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Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
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New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
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Somalia
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South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
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eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
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Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
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Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
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4
Email
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5
Phone Number
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Area Code
Phone Number
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6
Vehicle Name
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Name of your pulling vehicle
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7
Vehicle Make/Model
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Year make/model of your pulling vehicle
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8
Occupation
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9
Hobbies
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List your hobbies outside of pulling
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10
Recent Pulling Accomplishments
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List your most recent pulling accomplishments
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11
Upload Photo (Optional)
Add a recent pulling photo to use as your entry profile. We will use current one on file if one is not uploaded.
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Max. file size
: 10.6MB
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12
Clutch Paperwork
Print off, fill out & have your clutch paperwork notarized. Please download or print off the form before submitting. (You can get this notarized at your local post office, bank, or city hall.) Send the completed form back in order to finalize your registration. EVERY Puller must have a 2022 clutch paper notarized and on file to pull. NO EXCEPTIONS. You WILL NOT be entered until we receive this back. Thanks
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13
Terms and Conditions
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14
Registration Fee & Extra Pit Passes
*
This field is required.
Each puller gets 2 all weekend pit passes. Add any extra pit pass to your cart to receive them in advance. If you are entering multiples vehicles you will need to register each vehicle separately. If you are entering in multiple classes you will need to enter each class separately.
Registration Schedule:
Early Bird Price thru October 6th = $185
October 7th thru 27th = $210
October 28th thru Nov. 17th = $235
After Nov. 18th = $250
Click on the numbers to move thru your options to add to your cart. 1. Driver & Vehicle Registration Fee (Required) 2. Test & Tune (Optional) 3. Extra Pit Passes (Optional) 4. Water Injection Water
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ORDER SUMMARY
Processing Fee
USD
Subtotal
USD
Total cost
USD
Driver & Vehicle Registration Fee
Each entrance will receive 2 all weekend pit passes. Please add any extra pit passes if needed.
$
235.00
+
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Extra Pit Passes
Add extra pit passes if needed.
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Extra Pit Passes
Quantity
Price
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Water Injection Water
The ONLY water allowed during the Midwest Winter Nationals. They are 2.5 gallon jugs.
$
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Credit Card
First Name
Last Name
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Invoice ID
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2022 Midwest Winter Nationals 10,000 Pro Farm Registration Form
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