2022 Alcan 5000 entry form

August 23 - September 1, 2022

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 _________________________

Experience:

Fees and information

Entry Fee, autos ($3300): For one auto and 2 drivers, including rooms (double occupancy) & banquets.
Entry Fee, cycles ($2000): For one motorcycle & rider, including rooms (double occupancy) & banquets.
Third driver, autos ($1200): For 3rd person in any auto entry (double occupancy). Young passengers are $100 if rooming with parents.
Vehicles will start in numerical order, with priority for past winners & participants.
Entry deposit ($300): This will reserve a starting position and apply against entry fee. Deposit is non-refundable after January 10, 2022 and may not be transferred or sold.
Refund policy: Fees except $300 deposit are refundable through July 1, 2022. After that a $600 penalty is retained.

We accept checks, or send Square email invoices. Make checks payable to Alcan Rally or Rainier Auto Sports Club, Inc. Balance of fees are payable in full by June 1, 2022, and any unpaid will be dropped on June 10.
Organizers intend to start 30 autos and 20 cycles. Entries must be submitted on this form, including legible address & phone number for rider or primary driver (tba is OK for vehicle and secondary driver). Mail, e-mail, or fax to:

Alcan Rally
932 Sunnyfield Way | 425-823-6343 (VOIP)
Henderson, NV 89015 | 425-609-0084 (Fax)

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