Car # ___________   Class__________       
Fee Paid________      Postmark_________

Doo Wop ClubRally Entry Form
All Competitor and Service Crew members are required to sign the waiver prior to the start of the event. Entry is not complete unless all information is provided. Entry form must also include registrars initials to verity items in checklist
Driver Information                      Entering: Saturday____  Sunday____  Checklist
Name______________________________________________________________  Reistrar
Initials _____
Address____________________________________________________________ Driver License_____ 
City____________________________________   State_____  Zip____________   SCCA Mbr___
Telephone__________________             e-mail:___________________________    Comp Lic ____
Drivers License #_________________________  State_____   Exp._____
SCCA Membership #_________________  Competition License # ___________ Co-driver
License _____ 
Emergency Contact:_____________________________________ At event? Y/N SCCA Mbr____
Co-Driver Information
 Name__________________________________________________________         		 Comp Lic____
Address____________________________________________________________
City____________________________________   State_____  Zip____________   Vehicle
 Ins. & Reg.
Telephone__________________; e-mail:___________________________    Rally car_____
Drivers License #_________________________  State_____   Exp._____ Service   _____
SCCA Membership #_________________  Competition License # ___________
Emergency Contact:_____________________________________ At event? Y/N Waiver signed
Vehicle Information
 Car # _____   Car Class _______Year_______ Make_____________________		 Driver _____  
Model_______________________________    Color ____________ 
Engine Displacement ___________ 		 Co-Driver _____
Sponsors_________________________________________________________ Crew _____
Insured by____________________________ Policy Number__________________
Insurance Warranty - I warrant that the competition vehicle and all service vehicles(for the competition vehicle), have current minimum liability insurance coverage of $100,000/$200,000/$50,000 which meets or exceeds the vehicle insurance standards established and required by the SCCA.


__________________________________________________________________
Vehicle Owner Signature             / Printed Name               / Date
Read and Sign: I agree to compete under the current ClubRally rules of the SCCA and the supplementary rules pertaining to this event(s). I further affirm that the car I have entered complies with all the requirements for the class and category in which it is listed above. I am a member in good standing of the SCCA, Inc. Driver and Car owner agree to permit the use of their names, voice, likeness of themselves and their vehicles for new features and publicity articles used by all forms of media for the purpose of SCCA and sponsor advertising, event promotion, and other purposes of trade without compensation to the driver or owner.