David Pollie Classic Application Form

David Pollie Classic Application Form 2017-05-19T21:12:35+00:00

Please fill out the form below to submit your application for approval.

In addition to this applicant information, all applicants MUST submit a one-page "essay" highlighting their need for this Action Trackchair and their reasons why they should be awarded this prize. Please attach the essay using the file upload below, we can only accept PDF and Word Documents. Video submissions (5-10 minutes) are also allowed submitted to our email address below after submitting your application. Submit completed video no later than midnight, June 30th, 2017 to: davidpollieclassic -at- gmail -dot- com

File size max of 5MB, we can only accept PDF's and Word Documents.

By signing below and submitting this form, I agree to waive Michigan Operation Freedom Outdoors of all liability pertaining to the mobility device I have been awarded. I agree that in the event that I no longer have a need for, or the desire to own the mobility device provided to me by Michigan Operation Freedom Outdoors, I will contact Michigan Operation Freedom Outdoors to return the device so that another person may benefit from it.

I WILL NOT SELL THE DEVICE UNDER ANY CIRCUMSTANCE and hereby WILL the device that I receive from Michigan Operation Freedom Outdoors back to Michigan Operation Freedom Outdoors once I am no longer capable or desiring of using it.

I understand and agree to the provisions here and on the official rules and have receipt of this waiver.

To sign this form please use your mouse and click then drag your signature.

Date of Acceptance: 06/26/2017