2025 East Central Iowa Pullers Association Membership Form

2025 East Central Iowa Pullers Association Membership Form
Pay your 2025 ECIPA Membership via PayPal!

Please submit one (1) form per pulling vehicle.

If you need to pay for multiple vehicles, submit a seperate membership form for each pulling vehicle.
Please select membership type:*

MemberAdditional Crew Member
Driver Name*
Driver Name Pronunciation
Address*
City*
State*
Zip*
Phone #*
Email Address*
example@example.com
Class Pulling in for 2025*
What class will you be pulling in for the 2024 season?
Tractor/Truck Make*
What make/model is your pulling vehicle?
Tractor/Truck Name*
If no name, type "No Name".
T-Shirt Size*
Select your t-shirt size.
Additional Crew Member Name*
Enter the name of the additional crew member for insurance purposes.
- $300 for all classes if paid by April 15th, 2025
- $350 for all classes if paid after April 15th, 2025
- $400 if signing up the day of a pull
- $50 for one Additional Driver
- **$10 additional fee to pay online to cover PayPal charge**
- Membership will not be rolled over to following year if not used.
- No refunds after April 15th, 2025.
- ECIPA Member will be covered under ECIPA Insurance all at ECIPA Events.
Membership Type*

$310 Single Membership (2 pit passes)$360 Single Membership + Extra Driver (3 pit passes)
3 ECIPA Passes Max Per Pulling Vehicle
- ALL MEMBERS MUST SUBMIT 2025 NOTARIZED CLUTCH CERTIFATION FORM IN ORDER TO PULL AT ANY ECIPA PULL DURING THE 2025 SEASON!
  - Please print out and have the PDF below notarized and mailed into ECIPA prior to the first pull.
  - The form will also be linked to your membership submission confirmation email for you to print and have notarized.
My Products*
prevnext( X )
2025 ECIPA Single MembershipSelect this to sign up for a single membership (2 ECIPA Passes)
$310.00

2025 ECIPA Membership + Extra DriverSelect this to sign up for regular membership plus an extra driver (3 ECIPA Passes)
$360.00

Total

$0.00
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