ON LINE
ENTRY FORM
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EVENT NAME: Oregon Trail
EVENT DATE: April 22 - 24, 2005
 

All competitors and service crew members are required to sign the insurance waiver in the presence of the registrar prior to the start of the event. Entry is not complete unless all information is provided. Entry form must also include registrar's initials to verify items in checklist.

In which really will you compete?

Oregon Trail National

Oregon or Bust C3 Rally

Trail's End Club C2 Rally

DRIVER INFORMATION

Entrant

Name
Address
City
State Zip Code

Telephone

 Telephone (W)
E-mail
Driver's License #
 State Exp.
Member #
 Exp.
Competition Lic. #
 Exp.
In Case of Emergency
Are they at the Event?
 Ph#:

CO-DRIVER INFORMATION

Name
Address
City State Zip Code
Telephone (h) (w)
E-mail
Driver's License # State Exp.
Membership # Exp.
Competition License # Exp.
In Case of Emergency
At Event? Ph#:

VEHICLE INFORMATION

Car Number:

Car Class Year Make Model Color
Engine Displacement Tire Brand
Vehicle Lic. # State
Sponsor(s)

Insurance Warranty: I warrant that the competition vehicle and all service vehicles (for the competition vehicle),
have current minimum liability insurance coverage of $100,000/$200,000/$50,000 which meets or exceeds the vehicle insurance.

Policy Name
Policy Number

Pace Notes:

Do you require pace notes? Contact Rally America

READ & SIGN:

I agree to compete under the current Rally America
Rules and the supplemental rules pertaining to this event.  I further
affirm that the car I have entered complies with all requirements for
the class and category in which it is listed above.  Driver and car
owner agree to permit the use of their names, voice, likeness of
themselves and their vehicles for news features and publicity articles
used by radio, television, video and motion picture film, newspapers,
magazines and all other forms of media for the purpose of Rally America
and sponsor advertising, event promotion, and other purposes of trade
without compensation to the driver and/or owner.

 * * * YOU WILL BE REQUIRED TO SIGN A REGISTRATION FORM AT EVENT REGISTRATION * * *

Click the button to send your registration

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