August 15-18
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August 15-18 |
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Name _____________________________________ Address___________________________________ City/State/Zip_______________________________ Phone (___)_____________ Fax (___)__________ E-mail ____________________________________ Driver license # & state_____________________ Emergency contact _________________________ |
Name ____________________________________ Address__________________________________ City/State/Zip______________________________ Phone (____)______________________________ E-mail ____________________________________ Driver license # & state______________________ Emergency contact _________________________ |
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Year____________ Make_____________________ Model ____________________________________ License #____________________ State________ Color____________________________________ Owner ____________________________________ Insurance Company ________________________ Policy # ___________________________________ |
Name ____________________________________ Address___________________________________ City/State/Zip_______________________________ Phone (____)______________________________ E-mail ____________________________________ Driver license # & state_____________________ Emergency contact ________________________ |
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Related experience:
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| Entry Fee, autos ($700): Fee for one auto and 2 drivers.
Entry Fee, cycles ($550): Fee for one motorcycle and rider. Deposit ($100): Will reserve a starting position, and apply in full against total fees above. This deposit is non-refundable after May 1, 2005. Starting position: Vehicles will start in numerical order. Numbers will be assigned within group (auto or cycle) in the approximate order entries were received, except past winners. Refund policy: Entry fees (except deposit) are refundable through August 1, 2005. All entry packages include accommodations (double occupancy), 2 lunches, and an awards dinner. Other food, fuel, incidentals as well as reservations & fare for the overnight BC Ferry from Bella Coola to Port Hardy are the responsibility of the entrant. |
| Additional options...
* Third driver, autos ($150): For a 3rd driver in an auto (double occupancy). * Single supplement ($100): Additional fee per person for single occupancy accomodations |
| Visa, Mastercard, and PayPal are accepted. Make checks payable to Rainier Auto Sports Club Inc, or send PayPal to payments@RainierAutoSports.com Fees are payable in full by July 1, 2005. |
| We expect to start 25 entries, with up to 50% cycles. Mail or fax to: |
| Nor'Wester Rally
| (425)823-6343
12345 Lake City Way NE #301 | (425)823-6307 fax Seattle, WA 98125 | http://www.rainierautosports.com/ |
Credit Card Information Cardholder's name _____________________________________________________ Card Number ___________________________________________________________ Dollar amount of charge _______________________ Expiration Date _______Signature of Cardholder _________________________________________________ |
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