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					HISTORIC
GRAND
PRIX
                 ANNUAL RACE ENTRY APPLICATION FORM
This entry is for the following events (Please check ALL that apply)
Entry fee for each event is $950 USD.

*Savannah___ Lime Rock ___ Mt. Tremblant ___ *Road America ___ Infineon ___ *NJ Motorsports Park ___
(Events with an asterisk * will require their forms to be completed and submitted as well; all entry fee checks
should be sent to HGP East Coast office).

Entrant Name: __________________________________________________________

Address: _______________________________________________________________

City:_____________________________ State:_________ Zip:___________________

Business Tel: ________________________ Home Tel: __________________________

Fax: _________________________ E-Mail: ___________________________________

Car Make:_____________ Year: ________ Model: _______Chassis No. ____________

Transponder No.______________ Car Number Requested_________ 2nd________

FIA Historic Technical Passport (replaces HVIF): ____No _____Yes

Driver Name: __________________________________________________________

Address: ______________________________________________________________

City:_____________________________ State:_________ Zip:__________________

Business Tel: ________________________ Home Tel: _________________________

Fax: _________________________ E-Mail: __________________________________

License Type + No. ______________________ Issued by: _____________________


Indemnification: This agreement is between Driver (DRIVER) and/or Entrant (ENTRANT) and Historic
Grand Prix, Inc. (HGP), and each track and promoter. The DRIVER and/or ENTRANT shall indemnify and
hold harmless and its successors, assigns, officers, directors, members, owners, agents, affiliates and
employees from and against any loss, damage, cost or expense (including attorneys’ fees) that any of them
may incur as a result of the acts or omissions of DRIVER and/or ENTRANT or their agents or
representatives at or in relation to DRIVER’S and/or ENTRANT’S participation at the HGP Races in
conjunction with each track and promoter.
Agreement: Driver and Entrant hereby agree to adhere to the HGP Driving Code, The HGP
Philosophy, Procedures & Technical Rules as well as Statutes and Rules of each event and promoter;
and further acknowledges that failure to do so could result in exclusion from this event as well as
other 2009 events at the sole discretion of HGP. Driver and Entrant agree to sign the HGP Media
Agreement as a condition of their participation.

The Driving Code: The theater of the race meeting, and in particular that of the racing, is of
paramount importance. Without a happy spectator, the event fundamentally fails, and your
compliance with certain conditions is therefore crucial. Firstly, because the cars we are driving do not
enjoy the benefits of modern design and construction techniques, driving safely and courteously is
critical. We take a very strict view on driving styles.
          It is also crucial that you do not race off into the distance if you find yourself able to do. Drivers
are required to ‘play the game’ and help insure a decent challenge for the lead, or position. Drivers
who do achieve, maintain and/or improve on a substantial lead will not be invited to take part in
subsequent events. Please appreciate that we do not expect competitors to compromise their position
if in the lead, but equally we won’t entertain unnecessary heroics.

Signatures:

Entrant:                _________________________________________

Print Name:             _________________________________________

Date:                   _____________________________________2009


Driver:                 _________________________________________

Print Name:             _________________________________________

Date:                   _____________________________________2009

IF CREW LIST CHANGES FOR EACH EVENT, COPY THIS PAGE AS MANY TIMES AS NEEDED,
INDICATE CHANGES AND EVENT FOR WHICH CHANGES OCCUR AND SUBMIT AS USUAL.

Crew:                   1. ________________________________________

                        2. ________________________________________

                        3. ________________________________________

                        4. ________________________________________

                        (Entrant, if different from Driver must be listed as Crew)

Mail completed signed forms, check(s) and Medical Form to:
Rebecca Hale
Historic Grand Prix, Inc
4 Finch Road
North Salem, NY 10560
914.485.1108 – Office
rebecca@historicgrandprix.com