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First Name*

Last Name*

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D.O.B - Date of Birth requested for verification purposes only pursuant to 18 U.S.C. §§ 2256 et seq. 1918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 12345678910111213141516171819202122232425262728293031

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Show Questions

Tell us about your truck (Year, Make, Model, Horse Power, Tire Size, Wheel Size, Is it Street Legal):

What does your truck mean to you?:

Tell us about any modifications you have made to your truck (suspension, engine, chip, fuel, etc):

Tell us about your racing and/or off-roading experience:

Why do you want to compete on TRUCK NIGHT IN AMERICA?:

Is your truck equipped with a 5-point harness?:

Does your truck have a roll cage?:

Have you ever been convicted of any crimes, including a misdemeanor or a felony? If yes, please describe in detail, and include date, city, state, charge and sentence for each incident:

Have you ever had a temporary or permanent restraining order placed against you or has anyone sought a temporary or permanent retraining order against you? If yes, explain (Include date, city, state and circumstances):

How did you hear about the casting for TRUCK NIGHT IN AMERICA? Please Be Specific: (I.e. facebook, on-air promo, iconiccasting.com, etc.)?: