TRACTOR PLOWING CONTESTANT

ENTRY FORM & PRIVACY WAIVER

International Plowing Match & Rural Expo

September 22-26, 2015 - Stormont, Dunas & Glengarry Counties - Finch, Ontario

(Please Print Clearly)

Name:______Date of Birth: ______

Address: ______

Civic Address

______

CityPostal Code

Telephone: ______Email: ______

Emergency Contact: ______

County of Branch Membership: ______Class _____ Group _____

Number of Years You Have Been Plowing in Competition: ______

***Rules & Regulations Book – Pages 2 & 3 of the Rules & Regulations book list the changes and or additions to the Rules & Regulations in 2015.

QUALIFYING POINTS

This is to certify that I have received the minimum number of points as stated in Rule 1 of the 2015 Rules & Regulations Official Handbook.

a) Highest Points for 2014 or 2015: ______received at ______Branch Match

Please include a copy of the Branch Match Points form from the Branch you received the points, if possible.

Branch Secretary Signature: ______

OR

b) Points from previous year I.P.M. Match: ______

INSURANCE

I have enclosed a copy of my certificate of insurance, signed by a company representative and showing $2 million liability coverage, expiry date and the event named as an additional insured.

If you are borrowing equipment for the competition, please provide the following:

Name of Owner: ______

Phone Number of Owner: ______

The owner, as well as the contestant, must supply an insurance certificate signed by a company representative showing $2 Million liability coverage, expiry date and the event named as an additional insured.

***Mandatory: Please send in a Certificate of Insurance with your entry form.

ENTRY FEE / DEADLINE

An entry fee of $70.00 must accompany the entry form. ALL entriesmust be postmarked by August 15, 2015.

Make cheques payable to: Ontario Plowmen’s Association

*NSF Cheques – there will be a charge of $25 for a NSF cheque.

If paying by credit card: Visa / Master Card ______

Expiry Date: ______3 Security Numbers on Back of Card: ______

Practice Fields

As per Rules & Regulations Book – page 20 - Practice Plowing – this will be held on Monday only - prior to the IPM.

One – (1) land per competitor. Lots will be assigned when requested.

***Note: ALL of the ‘Practice Land’ must be totally plowed.

In order to calculate the number of lands that will be needed for plowing and practice lands we need to know if you will require practice land on Monday, September 15, 2015.

Please check off whether or not you require a practice land. Yes No

Accommodations:

Please circle one: Hotel RV Park Horse Park

BARBARA MCALLISTER MEMORIAL SCHOLARSHIP

Are you interested in the Plowing Scholarship? Yes _____ No ______

***Your County Secretary has the Scholarship Forms – Please contact your County Secretary to complete the Scholarship Forms and send them to the OPA Office. **All forms are required to be sent to the OPA Office. (The form the secretary completes as well as the forms you complete.)

QUEEN OF THE FURROW

Are you interested in coaching a Queen of the Furrow? Yes ____ No ____

Are you committed to a specific County Queen of the Furrow? Yes ____ No ____

If so, what county and the name of the Queen ______

PRIVACY WAIVER

The O.P.A. maintains a database of participants annually in order to keep all interested individuals up to date on activities of the O.P.A. and the I.P.M. including matches, special events, programs, services and the delivery of prize money. Photos taken at O.P.A. and I.P.M. events may be used to promote O.P.A., I.P.M. and other special events through the O.P.A. website and other promotional materials.

By participating in this event you are consenting to allow your name, town, placing and points to be listed on the website.

This information will not be sold or made available outside of the O.P.A.

For further information or to have specific names removed from our database please contact our Privacy Compliance Officer via the information above or at

I ______hereby give permission to allow the O.P.A. to maintain my / my son’s / daughter’s contact information within their internal database and to publish photos of myself / my son / daughter along with a listing of points earned at the match.

______

Signature of Competitor or Parent / GuardianDate

If Competitor is under 18 years of age

If you require a receipt please check here Yes ____ No ____

Checklist

(Just a reminder to make sure all requirements are completed)

Certificate of Insurance enclosed

Class 6 – Antique Tractor Form

Entry Fee enclosed

Entry Form completed – full mailing address

Scholarship application completedif applicable

Practice lot requested

Accommodationsconfirmed

(Please no faxes)

Any questions, please don’t hesitate to contact the OPA Office – 519-767-2928: 1-800-661-7569

Please mail forms and payment by August 15th to:

Ontario Plowmen’s Association, 188 Nicklin Rd., Guelph, ON N1H 7L5

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