ATA Truck Driving Championships Entry and Release
Minnesota Trucking Association Safety Council Presents:
Minnesota’s Truck Driving Championships Step Van Championships
June 11-12, 2011 Minneapolis, Minnesota
REGISTRATION FORMS
2011 Minnesota Truck Driving & Step Van Championships
Registration Information
DATE:
June 11-12, 2011
COMPETITION & AWARDS LOCATION: Koch Trucking, Inc. 424 Harding Street NE Minneapolis, Minnesota 55413 DISCOUNTED HOTEL ROOM RATES: Ramada Plaza Minneapolis (612) 331-1900 1330 Industrial Boulevard, Minneapolis, MN 55413 Room Block Rate is $79 plus tax per night. Please mention the Truck Driving Championships when booking your room(s). ELIGIBILTY: A city or road driver who drives for, or leases to, a common, contract, specialized or private carrier member of MTA shall be accident-free from June 13, 2011 and continuously employed by the entering employer for at least 12 months prior to entry and shall have driven and performed the duties of a professional truck driver for 11 of the 12 months prior to entry. Proof of CDL and any endorsements must accompany entry forms (a photocopy of MVR is sufficient). Drivers must be permanent residents of Minnesota or be occupationally domiciled in Minnesota. For questions, contact the MTA at (651) 646-7351. All entries must include the following: completed Minnesota Registration Form completed ATA TR-1 & TR-2 Entry Forms current MVR (dated no earlier than March 1, 2011) paid entry fee ENTRY FEE: $125 per driver – includes drivers award ceremony ticket plus one (1) for guest. Entry deadline is May 27, 2011. No registration forms or changes in the driver’s class of competition will be accepted after this date. Upon receipt of the entry forms and payment, MTA will supply an ATA “Facts for Drivers” book and shoulder patches for each driver entered. The state of Minnesota patch should be worn on the left shoulder and the ATA patch on the right shoulder. Additional patches are available at a nominal fee. CLASSES OF COMPETITION: Step Van, Straight Truck, Three-Axle, Four-Axle, Five-Axle, Tank Truck, Flatbed, Twin Trailer, and Sleeper Berth. NOTE: Companies may enter a maximum of three (3) drivers in each class of competition. AWARDS: First, Second and Third place winners will be presented with plaques. First place winners also have the opportunity to represent Minnesota in the ATA National Truck Driving Championships in August. Additional event awards include: Grand Champion Award Howie Johnson Memorial Trophy Rookie of the Year Award
Team Award Vehicle Inspection Award Written Knowledge Test Award ADDITIONAL ITEMS OF NOTE:
Operators must use their own equipment in company tryouts and in practice runs. The equipment used in the competition will be arranged for by the Minnesota Truck Driving Championships (TDC) committee.
No driver may practice on company time prior to the contest, nor be paid for practice time. Violations will disqualify a company from participation. Drivers should be encouraged to practice on their own time.
Companies are urged to adhere to the practice of paying competing drivers for actual working days only. A driver SHOULD NOT BE PAID for the weekend of the Championships if they are regularly scheduled days off. QUESTIONS? Rachel Greenwell, Minnesota Trucking Association Phone: (651) 646-7351 E-mail: [email protected] Dave Dailey, Koch Trucking, Inc., Committee Chair Phone: (763) 302-5400 E-mail: [email protected] Kim Heins, ProDrivers, Vice Chair Phone: (763) 571-6667
E-mail: [email protected]
2277 Highway 36 West #302 Roseville, MN 55113 Phone: (651) 646-7351 Fax: (651) 641-8995 www.mntruck.org
2011 Minnesota Truck Driving & Step Van Championships
Encourage Your Drivers to Register! Participating in any competition for the first time can be a nerve-wracking experience, but it doesn’t have to be! Give your drivers an idea of what is expected of them during the competion, and encourage them to register. They will be glad that they did. 1)
The MN Truck Driving Championships (TDC) is a two-day competition. The top three drivers from each class upon conclusion of the Saturday, June 11 running will compete on Sunday, June 12. All contestants are expected to stay for the entire two-day event and support their fellow drivers.
2)
New contestants are not alone. Every year there are “rookies” that join the competition for the first time. The Minnesota TDC committee is available throughout the competion for questions and makes sure that rookies understand what to do.
3)
Contestants are not allowed to have electronic communication devises (including cell phones) in their possession during the competition.
4)
When the event begins, each class will be assigned a “class director.” This individual will lead the group to each part of the competition.
5)
The event includes a written test. The best method to study for the written test is to read the ATA Facts for Drivers book that is provided to each driver upon registering.
6)
During the first day of the competition, all drivers are required to do a standard pre-trip inspection. Drivers have permission to bring the proper equipment to do a pre-trip inspection indoors or outdoors.
8)
The driving portion of the competition requires that the driver proceed in a pre-chosen vehicle through a variety of obstacle courses.
9)
The Championships Awards Ceremony is Sunday, June 12 at Koch Trucking, Inc.
10)
This is a great opportunity for your drivers to spend the weekend with the safest and best drivers in the state and to be in contact with the industry professionals that affect their day-to-day operations.
11)
Concessions are available throughout the weekend to contestants and spectators at a nominal fee. All proceeds support the Minnesota Truck Driving Championships.
2011 Minnesota Truck Driving & Step Van Championships
Registration Form
Event Date:
June 11-12, 2011
Location:
Koch Trucking, Inc. 424 Harding St NE, Minneapolis, MN 55413
*Entry fee includes a “2011 Facts for Drivers” handbook, a MN TDC patch, an ATA patch, and two (2) award ceremony tickets for the contestant. Additional patches and banquet tickets may be purchased.
NOTE: Companies may enter a maximum of three (3) drivers in each class of competition. Each driver must have the proper endorsement to compete in the desired class of competition and meet all other MTA Truck Driving Championships eligibility requirements. Registration Deadline: May 27, 2011.
DRIVER INFORMATION
DRIVER INFORMATION
ROOKIE?
ROOKIE?
Straight Truck
Sleeper Berth
1. _____________________________________ Yes No
1. _____________________________________ Yes No
2. _____________________________________ Yes No
2. _____________________________________ Yes No
3. _____________________________________ Yes No
3. _____________________________________ Yes No
Three-Axle
STEP VAN DRIVING COMPETITION
1. _____________________________________ Yes No
1. _____________________________________ Yes No
2. _____________________________________ Yes No
2. _____________________________________ Yes No
3. _____________________________________ Yes No
3. _____________________________________ Yes No
Four-Axle
COMPANY INFORMATION
1. _____________________________________ Yes No 2. _____________________________________ Yes No 3. _____________________________________ Yes No
Contact_ _____________________________________________ Company_____________________________________________ Address______________________________________________
Five-Axle 1. _____________________________________ Yes No
City________________________State_ ____ Zip____________
2. _____________________________________ Yes No
Phone_______________________________________________
3. _____________________________________ Yes No
E-mail_______________________________________________
Tank Truck
# of Competing drivers _ _____x $125. =___________________
1. _____________________________________ Yes No
# of Extra ATA patches_______ x $ 2. =____________________
2. _____________________________________ Yes No 3. _____________________________________ Yes No
# of Extra MN patches_ ______x $ 2. = ____________________ # Banquet Tickets (Adult)______ x $ 20. = ____________________ # Banquet Tickets (Child)______ x $ 10. = ____________________
Flatbed 1. _____________________________________ Yes No 2. _____________________________________ Yes No
Total Due*:__________________
3. _____________________________________ Yes No
*If an invoice number is needed to issue a check, please use invoice #TDC0611.
Twin Trailer
PAYMENT METHOD
1. _____________________________________ Yes No 2. _____________________________________ Yes No 3. _____________________________________ Yes No
Check enclosed (payable to the MTA Safety Council) Credit Card #__________________________________________ Exp. Date_____________________ CVO # *_______________ Name on Card_________________________________________ *The CVO # is a three or four digit number usually found on the back of your card.
Please mail or fax your registration to: Minnesota Trucking Association 2277 Highway 36 West #302, Roseville, MN 55113 Phone: (651) 646-7351 • Fax: (651) 641-8995
2011 Minnesota Truck Driving & Step Van Championships
Sponsorship Opportunties Sponsorship opportunities for MTA members are available for the Minnesota Truck Driving Championships on June 11 & 12. Sponsoring this special event is a high-profile way to get your name in front of those participating carriers, as well as spectators. For a minimum sponsorship of $100, sponsors are allowed to display a company banner or sign (of professional quality and reasonable size) on the course. In addition, all sponsors will be listed in Sunday’s awards ceremony program. Banners or signs must be dropped off at the MTA office on or before Friday, May 27. You are responsible for picking up your banner upon conclusion of the competition at the course on Sunday, June 12.
Please consider sponsoring this event! Important: To have your name included as a sponsor in the printed materials, your sponsorship form must be received before May 20, 2011. If you have any questions about sponsorship, please call the MTA office at (651) 646-7351.
Sponsorship Levels
Yes! I would like to contribute $_ ________ to sponsor the MTA Truck Driving Championships.
Name:__________________________________________
Diamond............................$500 or more
Company:_______________________________________
Gold..................................$300 to $499
Address:_ _______________________________________
Silver.................................$200 to $299
City:_________________ State:_________ Zip:__________ Phone:___________________ Fax:___________________
Bronze...............................$100 to $199 PAYMENT METHOD
Benefactors.......................up to $99
Please invoice me.
Check enclosed (payable to the MTA Safety Council)
Visa
Mastercard
Discover
Credit Card #_____________________________________ Expiration Date___________________________________ CVO # *_ _______________________________________ Name on Card____________________________________ *The CVO # is a three or four digit number usually found on the back of your card.
The Minnesota Truck Driving Championship Committee is also seeking in-kind equipment donations for the weekend competition.
I authorize the Minnesota Trucking Association to charge my credit card for TDC sponsorship. Signature________________________________________ Return this form before May 20, 2011 to:
To donate equipment, please contact Dick Gillespie at (612) 618-8544 or the Minnesota Trucking Association at (651) 646-7351. Minnesota Trucking Association 2277 Highway 36 West #302; Roseville, MN 55113 Phone: (651) 646-7351 Fax: (651) 641-8995
American Trucking Associations (ATA)
Truck Driving Championships & Step Van Driving Championships Entry and Release (Be sure to complete Driver Information Sheet on reverse side)
Contestant’s name:
Preferred Nickname:
State: Employer: Class of Competition (check one) Straight Truck
Five-Axle Tractor-semitrailer
Flatbed
Three-Axle Tractor-semitrailer
Five-Axle Sleeper Berth Tractor-semitrailer
Twin Trailers
Four-Axle Tractor-semitrailer
Tank Truck
Step Van
CERTIFICATION BY EMPLOYER. I hereby certify that I am aware of the provisions of Chapter V, Truck Driving Championships Eligibility Rules, of the ATA Truck Driving Championships Rules and Procedures, State and National and applicable appendixes including the Step Van Driving Championships rule summary; that the contestant named herein is eligible to compete under these rules; and that all information furnished about them is true to the best of my knowledge and belief.
Signature:
Title:
AGREEMENTS AND RELEASE In consideration of my being permitted to participate in ATA’s National and/or its affiliates’ Truck Driving Championships (TDC) or Step Van Driving Championships (SVDC) and be eligible for awards offered to participants, I hereby stipulate and agree to the following: 1. 2.
3.
4.
I acknowledge that I am not in the employ of ATA. Both as to myself and my heirs and personal representatives, I release ATA, its directors, employees, agents and/or any of its affiliates from any and all liability and any right of action that may arise from any damage or injury which I may receive while attending or participating in said National TDC or National SVDC. I grant ATA and its designated agencies exclusive right to make use of information about myself and of photographs supplied with this entry form, along with photographs subsequently taken under ATA’s direction, in publicity and advertising activities. I further agree to make myself available for publicity enterprises arranged by ATA, with newspaper and magazine writers and radio and television personnel. I will be bound by all orders, rules and regulations governing ATA’s National and/or its affiliates’ TDC or SVDC while participating in said competitions.
CERTIFICATION BY CONTESTANT. I certify that during the past 12 months: 1. 2. 3. 4. 5. 6.
7. 8.
I have been continuously employed as a truck or step van driver by my present employer [exception: 11 of 12 months if previous employer went out of business, and all other eligibility requirements are met, driver is still eligible]; and I have driven and performed the regular duties of a truck driver or step van driver for at least 11 of the 12 months, and that my regular duties of a truck driver or step van driver constituted not less than 60% of my work hours and at least 1200 hours annually. I have not been involved in a fleet motor vehicle or motor carrier vehicle accident in the course of such employment; I have the proper class Commercial Driver’s License (if a SVDC applicant, not required), plus required endorsement(s) for the class of competition indicated above; I hold a CDL from or have been occupationally domiciled in the state of ______________________. Occupational domiciled means the terminal, garage or other operating base from which the driver normally and usually works and/or is supervised. I did not win in the same class of competition at the state or regional Truck Driving Championships and then compete at the National TDC or SVDC in 2009 and 2010 or 2008 and 2009; I acknowledge that after competing in the same class of competition for two consecutive years, I must not compete in that same class for two consecutive years if I won at the state or regional TDC and then competed at the National TDC or SVDC. I further certify that I have not received any form of pay, bonus, prize or other consideration for time spent in practice as set forth in the ATA Truck Driving Championships Rules and Procedures, State and National. I acknowledge that any misstatement made with respect to my eligibility for the Truck Driving Championships or Step Van Driving Championships competition may result in the forfeiture of my right to compete or in my disqualification from said competition.
Driver’s Signature: Attach a photocopy of your MVR showing: 1. Your name and/or signature 2. Class of CDL (or License if SVDC applicant) Form TR-1 American Trucking Associations
(Rev. 1/11)
(middle)
(state)
(zip)
Home Phone: (
No
No
Line-haul
Non-Preventable:
(state)
(last)
(last)
(last)
(zip)
Spouse’s Name:
(state)
Form TR-2 American Trucking Associations
(zip)
Yes
No
State/National
Class
Position
Are you interested?
Have you ever been a member of America’s Road Team?
Yes
Yes
No
Year
Information sheet must be complete to be eligible for National competition! (Rev. 1/11)
No
(Please attach separate sheet if additional space is needed for above listing)
Year
Previous State/National Truck Driving Championships or Step Van Driving Championships in which you competed or volunteered:
Have you ever participated in a State Truck Driving or Step Van Championships?
Outline any unusual experiences, such as help at scene of accident, aid to motorists, life-saving and any awards you have received.
No
E-mail:
(city)
For State and National publicity purposes include: Recent 2” X 3” (or larger) head and shoulder photograph (may be e-mailed as instructed by State Championships Committee or hosting State Trucking Association), and The name of your hometown newspaper and the nearest large city to your hometown
Yes
Is your company a member of ATA?
Peddle
Yes
Local
Preventable:
Is your company a member of the State Trucking Association?
Usual Run:
Date of Last Accident:
Number of Accidents:
Lifetime Safe Driving Miles:
Number of Years with No-Accident Record:
(city)
(middle)
(middle)
(middle)
Length of Service in Trucking Industry:
(number-street)
(first)
(first)
(first)
Length of Service with Present Employer:
Contestant’s Home Terminal:
Terminal Manager:
Safety Director:
Important: Company President:
Yes
)
(number-street)
Children’s name(s)/age(s): (city)
Phonetic Spelling
Employer Main Office Address:
State:
(last)
Married:
(number-street)
(first)
Home Address:
Employer:
Class of Competition:
Contestant’s Name:
ATA Truck Driving Championships & Step Van Driving Championships Driver Information Form
Minnesota’s Truck Driving Championships Step Van Championships
June 11-12, 2011 Minneapolis, Minnesota
REGISTRATION FORMS
2011 Minnesota Truck Driving & Step Van Championships
Registration Information
DATE:
June 11-12, 2011
COMPETITION & AWARDS LOCATION: Koch Trucking, Inc. 424 Harding Street NE Minneapolis, Minnesota 55413 DISCOUNTED HOTEL ROOM RATES: Ramada Plaza Minneapolis (612) 331-1900 1330 Industrial Boulevard, Minneapolis, MN 55413 Room Block Rate is $79 plus tax per night. Please mention the Truck Driving Championships when booking your room(s). ELIGIBILTY: A city or road driver who drives for, or leases to, a common, contract, specialized or private carrier member of MTA shall be accident-free from June 13, 2011 and continuously employed by the entering employer for at least 12 months prior to entry and shall have driven and performed the duties of a professional truck driver for 11 of the 12 months prior to entry. Proof of CDL and any endorsements must accompany entry forms (a photocopy of MVR is sufficient). Drivers must be permanent residents of Minnesota or be occupationally domiciled in Minnesota. For questions, contact the MTA at (651) 646-7351. All entries must include the following: completed Minnesota Registration Form completed ATA TR-1 & TR-2 Entry Forms current MVR (dated no earlier than March 1, 2011) paid entry fee ENTRY FEE: $125 per driver – includes drivers award ceremony ticket plus one (1) for guest. Entry deadline is May 27, 2011. No registration forms or changes in the driver’s class of competition will be accepted after this date. Upon receipt of the entry forms and payment, MTA will supply an ATA “Facts for Drivers” book and shoulder patches for each driver entered. The state of Minnesota patch should be worn on the left shoulder and the ATA patch on the right shoulder. Additional patches are available at a nominal fee. CLASSES OF COMPETITION: Step Van, Straight Truck, Three-Axle, Four-Axle, Five-Axle, Tank Truck, Flatbed, Twin Trailer, and Sleeper Berth. NOTE: Companies may enter a maximum of three (3) drivers in each class of competition. AWARDS: First, Second and Third place winners will be presented with plaques. First place winners also have the opportunity to represent Minnesota in the ATA National Truck Driving Championships in August. Additional event awards include: Grand Champion Award Howie Johnson Memorial Trophy Rookie of the Year Award
Team Award Vehicle Inspection Award Written Knowledge Test Award ADDITIONAL ITEMS OF NOTE:
Operators must use their own equipment in company tryouts and in practice runs. The equipment used in the competition will be arranged for by the Minnesota Truck Driving Championships (TDC) committee.
No driver may practice on company time prior to the contest, nor be paid for practice time. Violations will disqualify a company from participation. Drivers should be encouraged to practice on their own time.
Companies are urged to adhere to the practice of paying competing drivers for actual working days only. A driver SHOULD NOT BE PAID for the weekend of the Championships if they are regularly scheduled days off. QUESTIONS? Rachel Greenwell, Minnesota Trucking Association Phone: (651) 646-7351 E-mail: [email protected] Dave Dailey, Koch Trucking, Inc., Committee Chair Phone: (763) 302-5400 E-mail: [email protected] Kim Heins, ProDrivers, Vice Chair Phone: (763) 571-6667
E-mail: [email protected]
2277 Highway 36 West #302 Roseville, MN 55113 Phone: (651) 646-7351 Fax: (651) 641-8995 www.mntruck.org
2011 Minnesota Truck Driving & Step Van Championships
Encourage Your Drivers to Register! Participating in any competition for the first time can be a nerve-wracking experience, but it doesn’t have to be! Give your drivers an idea of what is expected of them during the competion, and encourage them to register. They will be glad that they did. 1)
The MN Truck Driving Championships (TDC) is a two-day competition. The top three drivers from each class upon conclusion of the Saturday, June 11 running will compete on Sunday, June 12. All contestants are expected to stay for the entire two-day event and support their fellow drivers.
2)
New contestants are not alone. Every year there are “rookies” that join the competition for the first time. The Minnesota TDC committee is available throughout the competion for questions and makes sure that rookies understand what to do.
3)
Contestants are not allowed to have electronic communication devises (including cell phones) in their possession during the competition.
4)
When the event begins, each class will be assigned a “class director.” This individual will lead the group to each part of the competition.
5)
The event includes a written test. The best method to study for the written test is to read the ATA Facts for Drivers book that is provided to each driver upon registering.
6)
During the first day of the competition, all drivers are required to do a standard pre-trip inspection. Drivers have permission to bring the proper equipment to do a pre-trip inspection indoors or outdoors.
8)
The driving portion of the competition requires that the driver proceed in a pre-chosen vehicle through a variety of obstacle courses.
9)
The Championships Awards Ceremony is Sunday, June 12 at Koch Trucking, Inc.
10)
This is a great opportunity for your drivers to spend the weekend with the safest and best drivers in the state and to be in contact with the industry professionals that affect their day-to-day operations.
11)
Concessions are available throughout the weekend to contestants and spectators at a nominal fee. All proceeds support the Minnesota Truck Driving Championships.
2011 Minnesota Truck Driving & Step Van Championships
Registration Form
Event Date:
June 11-12, 2011
Location:
Koch Trucking, Inc. 424 Harding St NE, Minneapolis, MN 55413
*Entry fee includes a “2011 Facts for Drivers” handbook, a MN TDC patch, an ATA patch, and two (2) award ceremony tickets for the contestant. Additional patches and banquet tickets may be purchased.
NOTE: Companies may enter a maximum of three (3) drivers in each class of competition. Each driver must have the proper endorsement to compete in the desired class of competition and meet all other MTA Truck Driving Championships eligibility requirements. Registration Deadline: May 27, 2011.
DRIVER INFORMATION
DRIVER INFORMATION
ROOKIE?
ROOKIE?
Straight Truck
Sleeper Berth
1. _____________________________________ Yes No
1. _____________________________________ Yes No
2. _____________________________________ Yes No
2. _____________________________________ Yes No
3. _____________________________________ Yes No
3. _____________________________________ Yes No
Three-Axle
STEP VAN DRIVING COMPETITION
1. _____________________________________ Yes No
1. _____________________________________ Yes No
2. _____________________________________ Yes No
2. _____________________________________ Yes No
3. _____________________________________ Yes No
3. _____________________________________ Yes No
Four-Axle
COMPANY INFORMATION
1. _____________________________________ Yes No 2. _____________________________________ Yes No 3. _____________________________________ Yes No
Contact_ _____________________________________________ Company_____________________________________________ Address______________________________________________
Five-Axle 1. _____________________________________ Yes No
City________________________State_ ____ Zip____________
2. _____________________________________ Yes No
Phone_______________________________________________
3. _____________________________________ Yes No
E-mail_______________________________________________
Tank Truck
# of Competing drivers _ _____x $125. =___________________
1. _____________________________________ Yes No
# of Extra ATA patches_______ x $ 2. =____________________
2. _____________________________________ Yes No 3. _____________________________________ Yes No
# of Extra MN patches_ ______x $ 2. = ____________________ # Banquet Tickets (Adult)______ x $ 20. = ____________________ # Banquet Tickets (Child)______ x $ 10. = ____________________
Flatbed 1. _____________________________________ Yes No 2. _____________________________________ Yes No
Total Due*:__________________
3. _____________________________________ Yes No
*If an invoice number is needed to issue a check, please use invoice #TDC0611.
Twin Trailer
PAYMENT METHOD
1. _____________________________________ Yes No 2. _____________________________________ Yes No 3. _____________________________________ Yes No
Check enclosed (payable to the MTA Safety Council) Credit Card #__________________________________________ Exp. Date_____________________ CVO # *_______________ Name on Card_________________________________________ *The CVO # is a three or four digit number usually found on the back of your card.
Please mail or fax your registration to: Minnesota Trucking Association 2277 Highway 36 West #302, Roseville, MN 55113 Phone: (651) 646-7351 • Fax: (651) 641-8995
2011 Minnesota Truck Driving & Step Van Championships
Sponsorship Opportunties Sponsorship opportunities for MTA members are available for the Minnesota Truck Driving Championships on June 11 & 12. Sponsoring this special event is a high-profile way to get your name in front of those participating carriers, as well as spectators. For a minimum sponsorship of $100, sponsors are allowed to display a company banner or sign (of professional quality and reasonable size) on the course. In addition, all sponsors will be listed in Sunday’s awards ceremony program. Banners or signs must be dropped off at the MTA office on or before Friday, May 27. You are responsible for picking up your banner upon conclusion of the competition at the course on Sunday, June 12.
Please consider sponsoring this event! Important: To have your name included as a sponsor in the printed materials, your sponsorship form must be received before May 20, 2011. If you have any questions about sponsorship, please call the MTA office at (651) 646-7351.
Sponsorship Levels
Yes! I would like to contribute $_ ________ to sponsor the MTA Truck Driving Championships.
Name:__________________________________________
Diamond............................$500 or more
Company:_______________________________________
Gold..................................$300 to $499
Address:_ _______________________________________
Silver.................................$200 to $299
City:_________________ State:_________ Zip:__________ Phone:___________________ Fax:___________________
Bronze...............................$100 to $199 PAYMENT METHOD
Benefactors.......................up to $99
Please invoice me.
Check enclosed (payable to the MTA Safety Council)
Visa
Mastercard
Discover
Credit Card #_____________________________________ Expiration Date___________________________________ CVO # *_ _______________________________________ Name on Card____________________________________ *The CVO # is a three or four digit number usually found on the back of your card.
The Minnesota Truck Driving Championship Committee is also seeking in-kind equipment donations for the weekend competition.
I authorize the Minnesota Trucking Association to charge my credit card for TDC sponsorship. Signature________________________________________ Return this form before May 20, 2011 to:
To donate equipment, please contact Dick Gillespie at (612) 618-8544 or the Minnesota Trucking Association at (651) 646-7351. Minnesota Trucking Association 2277 Highway 36 West #302; Roseville, MN 55113 Phone: (651) 646-7351 Fax: (651) 641-8995
American Trucking Associations (ATA)
Truck Driving Championships & Step Van Driving Championships Entry and Release (Be sure to complete Driver Information Sheet on reverse side)
Contestant’s name:
Preferred Nickname:
State: Employer: Class of Competition (check one) Straight Truck
Five-Axle Tractor-semitrailer
Flatbed
Three-Axle Tractor-semitrailer
Five-Axle Sleeper Berth Tractor-semitrailer
Twin Trailers
Four-Axle Tractor-semitrailer
Tank Truck
Step Van
CERTIFICATION BY EMPLOYER. I hereby certify that I am aware of the provisions of Chapter V, Truck Driving Championships Eligibility Rules, of the ATA Truck Driving Championships Rules and Procedures, State and National and applicable appendixes including the Step Van Driving Championships rule summary; that the contestant named herein is eligible to compete under these rules; and that all information furnished about them is true to the best of my knowledge and belief.
Signature:
Title:
AGREEMENTS AND RELEASE In consideration of my being permitted to participate in ATA’s National and/or its affiliates’ Truck Driving Championships (TDC) or Step Van Driving Championships (SVDC) and be eligible for awards offered to participants, I hereby stipulate and agree to the following: 1. 2.
3.
4.
I acknowledge that I am not in the employ of ATA. Both as to myself and my heirs and personal representatives, I release ATA, its directors, employees, agents and/or any of its affiliates from any and all liability and any right of action that may arise from any damage or injury which I may receive while attending or participating in said National TDC or National SVDC. I grant ATA and its designated agencies exclusive right to make use of information about myself and of photographs supplied with this entry form, along with photographs subsequently taken under ATA’s direction, in publicity and advertising activities. I further agree to make myself available for publicity enterprises arranged by ATA, with newspaper and magazine writers and radio and television personnel. I will be bound by all orders, rules and regulations governing ATA’s National and/or its affiliates’ TDC or SVDC while participating in said competitions.
CERTIFICATION BY CONTESTANT. I certify that during the past 12 months: 1. 2. 3. 4. 5. 6.
7. 8.
I have been continuously employed as a truck or step van driver by my present employer [exception: 11 of 12 months if previous employer went out of business, and all other eligibility requirements are met, driver is still eligible]; and I have driven and performed the regular duties of a truck driver or step van driver for at least 11 of the 12 months, and that my regular duties of a truck driver or step van driver constituted not less than 60% of my work hours and at least 1200 hours annually. I have not been involved in a fleet motor vehicle or motor carrier vehicle accident in the course of such employment; I have the proper class Commercial Driver’s License (if a SVDC applicant, not required), plus required endorsement(s) for the class of competition indicated above; I hold a CDL from or have been occupationally domiciled in the state of ______________________. Occupational domiciled means the terminal, garage or other operating base from which the driver normally and usually works and/or is supervised. I did not win in the same class of competition at the state or regional Truck Driving Championships and then compete at the National TDC or SVDC in 2009 and 2010 or 2008 and 2009; I acknowledge that after competing in the same class of competition for two consecutive years, I must not compete in that same class for two consecutive years if I won at the state or regional TDC and then competed at the National TDC or SVDC. I further certify that I have not received any form of pay, bonus, prize or other consideration for time spent in practice as set forth in the ATA Truck Driving Championships Rules and Procedures, State and National. I acknowledge that any misstatement made with respect to my eligibility for the Truck Driving Championships or Step Van Driving Championships competition may result in the forfeiture of my right to compete or in my disqualification from said competition.
Driver’s Signature: Attach a photocopy of your MVR showing: 1. Your name and/or signature 2. Class of CDL (or License if SVDC applicant) Form TR-1 American Trucking Associations
(Rev. 1/11)
(middle)
(state)
(zip)
Home Phone: (
No
No
Line-haul
Non-Preventable:
(state)
(last)
(last)
(last)
(zip)
Spouse’s Name:
(state)
Form TR-2 American Trucking Associations
(zip)
Yes
No
State/National
Class
Position
Are you interested?
Have you ever been a member of America’s Road Team?
Yes
Yes
No
Year
Information sheet must be complete to be eligible for National competition! (Rev. 1/11)
No
(Please attach separate sheet if additional space is needed for above listing)
Year
Previous State/National Truck Driving Championships or Step Van Driving Championships in which you competed or volunteered:
Have you ever participated in a State Truck Driving or Step Van Championships?
Outline any unusual experiences, such as help at scene of accident, aid to motorists, life-saving and any awards you have received.
No
E-mail:
(city)
For State and National publicity purposes include: Recent 2” X 3” (or larger) head and shoulder photograph (may be e-mailed as instructed by State Championships Committee or hosting State Trucking Association), and The name of your hometown newspaper and the nearest large city to your hometown
Yes
Is your company a member of ATA?
Peddle
Yes
Local
Preventable:
Is your company a member of the State Trucking Association?
Usual Run:
Date of Last Accident:
Number of Accidents:
Lifetime Safe Driving Miles:
Number of Years with No-Accident Record:
(city)
(middle)
(middle)
(middle)
Length of Service in Trucking Industry:
(number-street)
(first)
(first)
(first)
Length of Service with Present Employer:
Contestant’s Home Terminal:
Terminal Manager:
Safety Director:
Important: Company President:
Yes
)
(number-street)
Children’s name(s)/age(s): (city)
Phonetic Spelling
Employer Main Office Address:
State:
(last)
Married:
(number-street)
(first)
Home Address:
Employer:
Class of Competition:
Contestant’s Name:
ATA Truck Driving Championships & Step Van Driving Championships Driver Information Form
