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Rally in the Valley

VIEWS: 4 PAGES: 1

									                                 Rally in the Valley
                            For Cars ( Vans, SUVs, Pickups )
                                  Preregistration Form
                                    Mail by August 16, 2003

1st Annual Rally in the Valley to be held on Saturday August 23, 2003 in Bradford, PA.
Registration opens at 11:00 AM at the Congress Street Zippo parking lot. Mail to:
Dennis Roesch, 24 Dennis Lane, Bradford, PA. 16701 by August 16, 2003.


                                Participant Information
Driver Name: __________________ Navigator Name: _____________________
Address: ______________________    Address:____________________________
City, State, Zip: ________________ City, State, Zip: ______________________
SCCA Member No_Yes_ Region _____ SCCA Member No_Yes_ Region ______
Are you a Minor? Yes__ Age___ No__ Are you a Minor? Yes__ Age____ No___


                                            Vehicle
Make: _______________ Model: ______________ Color: ___________ Year: _______
License Plate (Tag) Number: _____________ State: _________
Does the Driver or Navigator own this Vehicle? Yes __ No __ If no complete the following:
Name and Address of the owner: __________________________________
                                __________________________________
                                __________________________________


                                    Entry Information
Participation Fee: $20.00 per vehicle
Class: Novice: ______ Tourist ( More than 2 people in vehicle ): ______
Rallyist ( Experienced ) ____

The entrant warrants that an auto insurance policy with liability limits of $100,000 / $200,000 /
$50,000 is in force for each vehicle entered.

We certify this entry is in compliance with Road Rally regulations. Article G 10 ( Car
Registration ) and Article G 11 ( Classes ).

Driver: ________________________ Navigator: _____________________
Date: __________                 Date: ___________

Questions: Please call Dennis Roesch @ 814-368-5427, If no answer please leave a message and
I will return your call or email me at jbroesch@charter.net.

								
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