2023 Professional Truck Driving Championship Please fill out the below form carefully. If you have any questions or concerns please contact Danielle at 204-632-6600 or dtyszuk@trucking.mb.ca 2023 Professional Truck Driving Championship - Driver Registration 1. Competitor InformationName(Required) Email address(Required) Phone number(Required) Spouse/Partner Name Drivers Licence number(Required) 2. Please select the competition class you are entering(Required)Single-TandemTandem-TandemSuper B TrainTurn pike (only one entrant/company; must bring steel-toed boots for hook-unhook. Will be deducted points without proper footwear)3. Total number of years driving(Required) 4. Career mileage(Required) 5. Usual runCityHighway/Long HaulCombinationWinter Roads/Specialized Routes6. Is this your first time entering the Professional Truck Driving Championship?(Required) Yes No If you have completed previously, please list years of competition:7. Have you ever had a preventable accident?(Required) Yes No If yes, please provide the date of your last prevetable accident 8. Are you competing as a team?(Required) Yes No If yes, team name: 9. Will your spouse or partner be participating in the spouse competition?(Required) Yes No If yes, please provide their name: 10. Competitor Declaration(Required) I have not been involved in a preventable motor vehicle accident, either in my personal or professional driving. I have not been employed by more than 2 employers. I certify that during the past 5 years I have not had any Criminal Code driving convictions registered against me. I certify that I have an air brake endorsement on my driver’s license. I certify that I am LCV Certified and registered with MTA or STA. (Turnpike only) Select All11. I further certify that:(Required) I currently hold a valid Manitoba or Saskatchewan driver’s license for the competition class I am entering. I am not employed by the Manitoba Trucking Association or the Saskatchewan Trucking Association. The information provided in this entry form is correct to the best of my knowledge. 12. In consideration of my being permitted to participate in the Manitoba Trucking Association Competition known as “The Manitoba Professional Truck Driving Championships” and to be eligible for awards offered, I hereby agree to the following:(Required) For myself and on behalf of my heirs and personal representatives, I release the Manitoba Trucking Association from any and all liability and any right to action that may arise from any damage or injury which I may receive while attending or participating in said competition, or loss of income from any activity. The Manitoba Trucking Association, or its assigns, shall have the right to use any photographs taken of me at or in connection with the competition for whatever purpose, whether advertising, promotion, or exhibition. I will be bound by all orders, rules and regulations governing the Manitoba Professional Truck Driving Championships. 13. Upload Driver's Abstract, dated between May 01/23 - May 31/23Max. file size: 16 MB.14. Employer InformationCompany name(Required) Company contact(Required) Company contact email(Required) Company contact phone number(Required) 15. Employer Declaration: By selecting the "I agree" button, you are signing this document electronically. You agree your electronic signature is the legal equivalent of your manual signature on this document.(Required) I agree Drivers Awards Banquet16. Competitor tickets(Required) I will not be attending the Driver Awards Banquet (do not need either ticket that comes with registration). I need ONE ticket for the Driver Awards Banquet (only one of the tickets that comes with registration). I need TWO tickets for the Driver Awards Banquet (both tickets that come with registration). 17. If you would like to have everyone from your company sit together (drivers and company reps), please indicate the number of tables we should set aside in your name. The tables are rounds of 10.(Required) Please reserve # of tables for our company. Industry Highlights Industry Awards Driver Recognition Programs MTA Scholarship Awards Industry Surveys Top Fleet Employers Driver Inc Truckers Against Trafficking
