***Please fill out the form in its entirety. If you fail to meet the requirements, you will not be awarded any monetary payout. Please read the Terms & Conditions prior to filling out the form.***

Name:

E-Mail address:

Mailing address:

Event name:

Event date:

What place did you finish?

What is the payout for this finish?

Division:

What tires did you use in this race?

What are your social media handles (Facebook, Instagram, Twitter etc.)?

Please upload your pictures (in dwg, pdf, jpg or png format):

Pictures required: 1.) winner on podium. 2.) Picture showing that you have met the helmet and logo requirements. 3.) Picture of OTR tires on the vehicle.