2004 Alcan Winter Rally entry form

2004 Alcan Winter Rally

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 ($2600): The entry fee for one vehicle and 2 drivers, including all accommodations and banquets.
Third Driver ($500): Additional fee for a 3rd driver or team member.
Entry deposit ($200): This will reserve a starting position, and apply in full against total entry fees above. This deposit is refundable through September 1, 2003.
Starting position: Car numbers will be assigned in the approximate order that entries are received, with priority given to past Alcan winners and participants.
Advertising waiver ($500): Fee for the waiver of the event's advertising display requirements (applies only in rare situations, see regulations for details).
Refund policy: Entry fees (less deposit) are fully refundable through January 10, 2004. After that date a $500 penalty will be retained.

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 December 10, 2003 (a $100 discount will apply for full payment by this date). The limit will be 30 teams, with 10 positions reserved for first-time entrants. Mail, e-mail, or fax to:

Jerry Hines                     |       jhines@eskimo.com
Chairman, 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 the above form, set your font preferences to 10 or 11. (To do this in Netscape, click 'options', 'general preferences', 'fonts', and 'choose font' for the proportional font size at 10 or 11).

2004 Alcan Winter Rally

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