SCCLAC/LOL SCCA/WAG
Wisconsin Glacier Trails VI Entry Form
Saturday, May 5, 2001
| Driver _________________________________ | Navigator ______________________________ |
| Address _______________________________ | Address _______________________________ |
| City/State/Zip____________________________ | City/State/Zip____________________________ |
| Phone _(______)_________________________ | Phone _(______)_________________________ |
| E-Mail_________________________________ | E-Mail_________________________________ |
| Region/Number _________________________ | Region/Number _________________________ |
| Minor? Y N | Minor? Y N |
| In case of Emergency, notify: | In case of Emergency, notify: |
| Name _________________________________ | Name _________________________________ |
| Phone _(______)_________________________ | Phone _(______)_________________________ |
| Drivers' License # ___________________________________ State _____ |
| Vehicle Year, Make, Model _________________________________________________________ |
| Color _______________ License ___________ State _____ Insurance Co. ___________________ |
Class Entered (please circle) EQUIPPED LIMITED STOCK ROOKIE VINTAGE
Circle the Event(s) You Are Entering: NATIONAL DIVISIONAL
I hereby warrant that the above vehicle is on the road legally, is being used by the entrant with the owner's permission, and is covered by liability insurance of not less than $20,000/$40,000/$10,000, or the minimum requirements in the state of registry, whichever is higher. I further warrant that the vehicle is in safe operating condition and that the safety items listed below have been checked and are in good working order.
Entrant/Owner's signature ________________________________
The driver warrants that she/he is in possession of a valid operators license.
| Driver's Signature________________________ | Navigator's Signature______________________ |
How did you learn about this event? ___________________________________________________
| Entry Fee ___________ | Paid ______________ | Date Rec'd __________ | Generals Mailed ______ |
VEHICLE INSPECTION
The following items must be in proper working order:
| ____ Headlights (High/Low beams) | ____ Foot Brake |
| ____ Parking, tail, directional and stop lamps | ____ Parking Brake |
| ____ Horn | ____ Tires (condition of sidewall and tread) |
| ____ Windshield wipers and washers | ____ Seat belts (securely installed for driver |
| ____ Rear view mirrors | and all passengers) |
Send completed signed entry form & fees to Registrar: Fred Rosevear, 5013 Lake Mendota Dr., Madison, WI 53705. Make checks payable to SCCLAC. Note: All return communication (Generals, Entry Lists, Results) will be by e-mail.