Alcan Winter Rally entry form

Alcan Winter Rally entry
February 23 to March 2, 2012

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 ___________________________

Related experience:

Fees and information

Entry Fee, autos ($2900): Fee for one auto and 2 drivers. Includes accommodations for 9 nights (double occupancy), plus banquets.
Entry reservation ($200): This reserves a starting position, and will apply in full against total fees. Non-refundable after August 1, 2011.
Starting position: Vehicles will start in numerical order. Numbers will be assigned in the approximate order entries were received, with adjustments for past Alcan winners and teams.
Refund policy: Entry fees (except reservation) are fully refundable through January 15, 2012. After this a $500 room cancellation penalty will be retained.

Related options...

Third driver ($700): Additional fee for a 3rd driver or team member (double occupancy).
Single supplement: Please inquire, not available at all locations.

Visa, MasterCard, and checks are accepted. Make checks payable to Alcan Rally or Rainier Auto Sports Club, Inc. All fees are payable in full by December 15, 2011.

Mail, e-mail, or fax to:

Alcan Rally                 |       425-823-6343

12640 88th PL NE        |       425-609-0084 fax

Kirkland, WA 98034    |      www.alcan5000.com

Credit Card Information

Cardholder's name ___________________________________________________________

Card Number __________________________________________________________________

Dollar amount of charge ________________________ Expiration Date _____________

Signature of Cardholder ______________________________________________________

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