Personal

First Name*

Last Name*

Gender Male Female

D.O.B - Date of Birth requested for verification purposes only pursuant to 18 U.S.C. §§ 2256 et seq. 1925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 12345678910111213141516171819202122232425262728293031

Contact Information

Address

City*

State (Province) AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingBritish ColumbiaAlbertaSaskatchewanManitobaOntarioQuebecNew BrunswickNova ScotiaPrince Edward islandNewfoundland & LabradorNorthwest TerritoriesYukon TerritoriesNunavut

Mobile*

Home Phone

Email*

Facebook / Twitter / Other

Education / Employment Information

Occupation

Show Questions

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

What does your truck mean to you and how is it part of your life?:

What is this trucks name and what is the backstory of how it got its name?:

Tell us about your racing and/or off-roading experience. What is the craziest thing you have ever done in your truck?:

Why do you want to compete on TRUCK NIGHT IN AMERICA? What would you do if you won the $10K?:

Who is your biggest supporter? What would you do for them if you win?:

Who doesn’t believe in you? Who do you want to prove wrong? How would you rub it in their face if you win? :

How has this truck changed your life? :

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.)?: