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 ______________________________________________________ 
    
    
    
    
    To best print the above form, set your font preferences to 10 or 11. (To do this in Netscape, click 'options', 'general preferences', 'fonts', and 'choose font' for the proportional font size at 10 or 11).

    Back to the Alcan information page