Please print this form and send it with a check  for $35 to

Heartland Truck Pullers Inc.

Denise Vanderweyst

19 Lone Ridge Lane

Foley, Mn. 56329

Name: _______________________________________
Address: _______________________________________
City: ______________ State: _____ Zip: __________
Email: ______________ Phone: ___________________

Truck info

Make: ______________
Name: ______________
Engine size: ______________

Classes

 Improved Stock
Pro Stock
Street Modified
Open