2002 Alcan 5000 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, Autos ($2500): Fee for one auto and 2 drivers, including accommodations (double occupancy) and banquets.
  • Entry Fee, Cycles ($2250): Fee for one motorcycle and driver, including accommodations (double occupancy) and banquetst.
  • Third driver for cars, or second for cycle ($500): Additional fee for a 3rd driver in an auto, or the second rider for a motorcycle (this would allow cycle riders to trade off, and includes transport for the second rider in official vehicles).
  • Entry deposit ($250): This will reserve a starting position, and apply in full against total fees above.  This deposit is refundable through December 31, 2001.
  • 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.
  • Advertising waiver ($500): Fee for the waiver of the event's advertising display requirements (see regulations for details).
  • Refund policy: Entry fees are fully refundable through July 1, 2002. After that date refunds will be 50% in cash and 50% in the form of a credit towards a future Alcan event.
  • Visa, Discovery, and Mastercard are accepted. All fees must be paid in full by June 1, 2002.
  • Motorcycle rentals are possible through Jamie Gleason, who operates Arctic Motorcycle Tours and Rentals in Whitehorse.  Jamie has 6 or 8 Kawasaki KLR 650's available for the event at a rate of $150/day in Canadian dollars (under $100 US at fall 2001 exchange rates).  He will pick up and deliver at no cost.

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    The limit will be 40 teams (20 automobiles and 20 motorcycles). Mail, e-mail, or fax to: 

    Jerry Hines                     |       jhines@eskimo.com
Alcan Rally Chairman            |       (425)823-6343
9805 NE 116th St, #180          |       (425)823-6307 fax 
Kirkland, WA 98034              |       www.alcan5000.com
    Credit Card Information
    Cardholder's name ____________________________________________________________
    Card Number __________________________________________________________________
    Dollar amount of charge _________________________ Epiration Date _____________
    Signature of Cardholder ______________________________________________________ 
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