2004 Alcan 5000 entry form

2004 Alcan 5000

Official Entry Form

DRIVER

Name _______________________________________

Address______________________________________

City/State/Zip_________________________________

Phone (___)_____________ Fax (___)_____________

E-mail ______________________________________

Driver license # & state________________________

Emergency contact ____________________________

SECOND DRIVER

Name _______________________________________

Address______________________________________

City/State/Zip_________________________________

Phone (___)_____________ Fax (___)_____________

E-mail ______________________________________

Driver license # & state________________________

Emergency contact ____________________________

VEHICLE

Year_____________ Make______________________

Model _______________________________________

License #____________________ State___________

Color___________________

Owner ______________________________________

Insurance Company __________________________

Policy # _____________________________________

THIRD DRIVER

Name _______________________________________

Address______________________________________

City/State/Zip_________________________________

Phone (___)_____________ Fax (___)_____________

E-mail ______________________________________

Driver license # & state________________________

Emergency contact ____________________________

Previous experience:

Fee and reservation information

Entry Fee, Autos ($2800): Fee for one auto (modern or vintage) and 2 drivers, including ferry transport, accommodations (double occupancy) and banquets. "Vintage" means 1984 & older, or looks the same (Audi 4000, BMW 320, Omni GLH, Porsche 944, Saab 900, etc)
Entry Fee, Cycles ($2200): Fee for one motorcycle and driver, including ferry transport, accommodations (double occupancy) and banquets.
Entry deposit ($200): This will reserve a starting position, and apply in full against total fees above. This deposit is non-refundable after December 31, 2003.
Starting position: Car numbers will be assigned within group (auto or cycle) in the approximate order that entries are received, with a few numbers reserved for past Alcan winners and factory teams.
Refund policy: Entry fees (except deposit) are fully refundable through July 14, 2004. After that date a $500 penalty will be retained.
Motorcycle rentals are possible through Jamie Gleason, who operates Arctic Motorcycle Tours and Rentals in Whitehorse.

Additional options...

Third driver for cars, or second for cycle ($600): Additional fee for a 3rd driver in an auto, or an alternate motorcycle rider (double occupancy)..
Single supplement ($400): Additional fee (per person) for a single occupancy room.
Advertising waiver ($500): Fee for the waiver of the event's advertising display requirements (this applies only in rare situations, see regulations for details).

Visa and Mastercard are accepted. Make checks payable to Alcan Rally or Rainier Auto Sports Club, Inc. All fees should be paid in full by June 18, 2004. Inside Passage ferry transport (value $140 per cycle team, $300 per auto) is included only for entries paid in full by July 1. After that date reservations must be made and purchased by each entrant. (NOTE: The ferry cruise is part of the official route. Teams may arrive at the finish by an alternate route, but will be penalized for controls missed on day #9).

The limit will be 40 teams, with a reasonable balance of cycles & cars. Mail, e-mail, or fax to:

Alcan Rally                            |       (425)823-6343
12640 88th PL NE                   |       (425)823-6307 fax
Kirkland, WA 98034              |       www.alcan5000.com

Credit Card Information

Cardholder's name ____________________________________________________________

Card Number __________________________________________________________________

Dollar amount of charge ________________________ Expiration Date _____________

Signature of Cardholder ______________________________________________________

To best print this form, set your font to 10 or 11. (In Netscape, click 'options', 'general preferences', 'fonts', and 'choose font' for the proportional font size at 10 or 11).

2004 Alcan 5000

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