2010 Alcan 5000 entry form

2010 Alcan 5000

Official Entry Form

DRIVER or RIDER

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, including accommodations (double occupancy) and banquets.
Entry Fee, cycles ($2000): Fee for one motorcycle and rider, including accommodations (double occupancy) and banquets.
Entry deposit ($200): This will reserve a starting position, and apply in full against total fees above. This deposit is non-refundable after December 1, 2009.
Starting position: Vehicles will start in numerical order. Numbers will be assigned within group (auto or cycle) in the approximate order entries were received, with priority for past Alcan winners and participants.
Refund policy: Entry fees (except deposit) are fully refundable through July 1, 20010. After July 1 a $500 penalty will be retained.

Additional options...

Third driver, autos ($700): For a 3rd driver in an auto entry (double occupancy). Passengers under 16 are $100 if sharing with parents
Paid passengers ($900): Includes accomodation (double occupancy) and banquets, plus transportation in staff vehicles. Reserved for press, alternate motorcycle riders, or others closely associated with a paid entry. This is on a space-available basis, early confirmation is important!
Single supplement ($500): Additional fee for single occupancy accomodations if available.
Advertising waiver ($500): Fee for the waiver of the event's advertising display requirements (this applies only in rare situations, see regulations for details).

Visa, Mastercard, and checks are accepted. Make checks payable to Alcan Rally or Rainier Auto Sports Club, Inc. The balance of fees is payable in full by June 1, 2010.

We expect to start 50 entries, with a reasonable balance of cycles & autos. 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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