Name of Owner or Driver (Please Print) ________________________________

Address (Please Print) ______________________________________________

City/State/Zip (Please Print) __________________________________________

Year, Make, & Model of Vehicle (Please Print) ___________________________

Vehicle Name (Please Print) _________________________________________

The undersigned guarantees that the competition vehicle described above is currently equipped, and will be continually equipped, with all clutch assembly, flywheel, bellhousing components and required shields that are equal to, or exceed, the minimum safety requirements as defined in the 2010 Midwest Pullers Association rules, while participating in any Midwest Pullers Association sanctioned event.

The undersigned understands that this guarantee of compliance with all 2010 Midwest Pullers Association rules for all clutch assembly, flywheel, bellhousing components and required shields expires on December 31^st, 2010.

________________________________________ ______________________

Signature of Owner or Driver Date