1998 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 (updated 6-10-98)
  • Entry Fee ($2350): The entry fee for one vehicle and 2 drivers, including 9 nights accommodations, banquets, and Alaska ferry transport with staterooms.
  • Third Driver ($450): Additional fee for a 3rd driver or team member. A 4th member is possible by special request, but discouraged unless you are driving a large and comfortable vehicle.
  • Entry deposit ($250): This will reserve a starting position, and apply in full against total entry fees above.  Actual car numbers will be assigned August 10, teams not paid in full by that time will start last.
  • Advertising waiver ($500): Fee for the waiver of the event's advertising display requirements (see regulations for details).
  • Refund policy: Fees and deposits are fully refundable through July 29, 1998. 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 should be paid in full by July 15, 1998.

    • The limit will be 25 entries, with 10 positions reserved for first-time entrants. Mail, e-mail, or fax to: 

    Jerry Hines                     |       jhines@eskimo.com
Alcan Rally Chairman            |       (425)823-6343
13 Central Way #300             |       (425)823-6307 Fax 
Kirkland, Washington 98033      |       http://www.eskimo.com/~jhines/
    Credit Card Information
    Cardholder's name ____________________________________________________________
    Card Number __________________________________________________________________
    Dollar amount of charge _________________________ Epiration Date _____________
    Signature of Cardholder ______________________________________________________ 
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