River Valley Chamber of Commerce
Fun & Wonder TSD Rally 1998
Rumford, Maine
July 30,1998
ENTRY FORM
| DRIVER
Name:________________________________
Address:______________________________
City, State,ZIP:________________________
Phone:_______________________________
Minor (under 19 years of age)?____Yes___No
|
NAVIGATOR
Name:_______________________________
Address:______________________________
City, State, ZIP:________________________
Phone:________________________________
Minor (under 19 years of age)?___Yes___No
|
VEHICLE
Vehicle Make & Model______________________________________________Year_______
Color_________________________License Plate__________________________State_____
Insurance Co._____________________Policy#____________________Expires___________
Does either contestant own this vehicle?____Yes_____No
If NO, indicate the name and address of the owner__________________________________
CLASS
____A____B____C____JEEP____NOVICE (less than 5 rallys)
ENTRY FEES: (See flyer for entry fees) Amount enclosed: $___________
|
The Entrant warrants that an Auto Insurance policy with liability limits of not less than
$25,000/$50,000/$25,000 is in force for each vehicle entered. In signing this form I agree to abide by
all the regulations and decisions of the Rally Committee (If either the Driver or the Navigator is under
18, a minor release form must be obtained and filled out before the rally.)
|
____________________________
Signature of Driver
|
____________________________
Signature of Navigator
|
Please send this form to the address
below with checks made payable to:
River Valley Chamber of Commerce
P.O. Drawer 598
Rumford, ME 04276
|
ADMINISTRATIVE USE ONLY
Car # assigned____________
|
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