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2012 Registration


SECTION 1: ENTRANT IDENTIFICATION

(Routine Correspondence goes to the Entrant.)

SECTION 2: DESCRIPTION OF VEHICLE

(Certificate of Liability Insurance from Insurance Company on race and support vehicles required by May 15, 2012.)
(if yes, please explain below.)
(if no, please explain below.)
(This information determines age factor refer to V.D of Event Regulations. This section of data goes to the Event Technical Director for Technical Inspection purposes.)

SECTION 3: OWNER IDENTIFICATION

 Yes

SECTION 4: COMPETITION DIVISION/AWARD ELIGIBILITY

(please refer to Event Regulations I.E.)

SECTION 5: DRIVER IDENTIFICATION

(Please note: if you have an Alternate Driver, please provide the above information on a separate sheet when you mail completed application package to us.)

SECTION 6: NAVIGATOR IDENTIFICATION


SECTION 7: SUPPORT CREW IDENTIFICATION

(Please provide if you have it -although this can be provided at a later date.)

Crew Member #1

Crew Member #2


SECTION 8: SUPPORT VEHICLE

Please read Section II.E. of the Event Regulations. Each contestant vehicle entered may have one official support vehicle at no charge. If you share support with another team, or have additional vehicles, please indicate below. (Private and X-Cup Entry Support Vehicles should not exceed 45' total length, see section II.E.1.b of the Event Regulations.)
 
 
 


Please leave this field empty.

SECTION 9: RECIPIENT OF PRIZE MONEY

(Great Race will issue a 1099 to party receiving the check.)

SECTION 10: SPONSOR IDENTIFICATION

(For Business/Corporate Sponsored Entries only.)

SECTION 11: TERMS AND CONDITIONS OF ENTRY

1. The entry fee, as stated herein, is for one vehicle entered in the 2012 Great Race (the “Event”).

2. Owner/Entrant understands that this entry is a conditional offer to participate and if accepted, constitutes an agreement with The Great Race to take part in the Hemmings Motor News 2012 Great Race (hereinafter “Great Race”), unless otherwise prevented by circumstances beyond the control of Owner/Entrant. 3. The undersigned agrees for himself/herself and his/her team to comply with all federal, state and local laws related in any way to the Event.

4. The undersigned certifies that to the best of his/her knowledge all information on this form is true and correct, and that licenses and insurance policies listed above are and will be legally valid and in force throughout the duration of the Event and further that he/she has the authority to provide such information to the Great Race.

5. The undersigned further acknowledges that All Participating Crew and Support members must sign an insurance waiver and indemnity agreement in order to participate in the Event.

6. The undersigned agrees that all hotel reservations are to be made through Covington Travel using their online registration site.

7. The undersigned further acknowledges receipt of the Great Race Event Regulations and acknowledges and represents that he/she has (a) thoroughly read the Event Regulations; (b) understands the Event Regulations including without limitation the rules and regulations pertaining to prizes; and, (c) agrees to comply with all such regulations as well as any and all supplemental regulations that may be subsequently issued by the Great Race.

8. Finally, the undersigned acknowledges that All Participating Crew and Support members must agree to permit Great Race, the promoter of the Event, and their assigns, the use of their name, voice and/or likeness and photographic/ videographic images of them and their vehicle for news, publicity and feature use, films and video, newspapers, magazines and all other media in connection with advertising and for purposes of trade.

 

Call us at 1-800-989-RACE (1-800-989-7223), toll free.
1317 Chestnut Street
Chattanooga, Tennessee 37402
Email: jeffs@coker.com

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