2011 Pikes Peak International Hill Climb Vintage Division Automobiles Race Entry Packet

Transcription

1 2011 Pikes Peak International Hill Climb Vintage Division Automobiles Race Entry Packet *This request for invitation must be completed in full to include photos and payment. The Pikes Peak International Hill Climb, a sanctioned event of the Pikes Peak Auto Hill Climb Educational Museum, will be governed by the 2011 Official Rule Book and Vintage Division Automobiles Rules. *The completion of this form does not constitute acceptance into this event. *REGISTRATION DEADLINE - JUNE 1, 2011 *Photos and history are due by April 1, 2011 in order to be included in the Race Program. Entries for the Vintage Division Automobiles are processed by Rocky Mountain Vintage Racing. See Section 7 in this packet for details. 1 12/20/10

2 SECTION 1 OWNER INFORMATION (print and complete this form) Name: (last, first, m.i.) Address: City: State or Country: Postal Code: TELEPHONE / / WEB SITE Home: Cellular: Fax: Office: Web Site: DRIVER / RIDER INFORMATION Check if same as Owner Name: (last, first, m.i.) Address: City: State or Country: Postal Code: TELEPHONE / / WEB SITE Home: Cellular: Fax: Office: Web Site: DRIVER / RIDER DATE OF BIRTH: Driver/Rider T-Shirt Size: XXXL XXL XL L M S MEDICAL INSURANCE - All drivers / riders MUST have medical insurance at the time of any PPIHC sanctioned event to participate. Copies of proof of insurance must be provided at Registration. NOTICE TO ALL INTERNATIONAL PARTICIPANTS: Please verify with your health insurance company that your coverage extends to injuries resulting from participation in a racing event overseas as many policies specifically exclude coverage for racing injuries and/or injuries occurring overseas (outside of the coverage territory). DRIVER / RIDER - MEDICAL INSURANCE CARRIER: POLICY NUMBER: 2 12/20/10

3 SECTION 2 CO - DRIVER INFORMATION Name: (last, first, m.i.) Nickname: Address: City: State or Country: Postal Code: TELEPHONE/ / WEB SITE Home: Work: Fax: Cellular: Web Site: CO-DRIVER/RIDER DATE OF BIRTH: Co-Driver/Rider T-Shirt Size: XXXL XXL XL L M S MEDICAL INSURANCE - All drivers/riders and co-driver/riders MUST have medical insurance at the time of any PPIHC sanctioned event to participate. Copies of proof of insurance must be provided at registration. NOTICE TO ALL INTERNATIONAL PARTICIPANTS: Please verify with your health insurance company that your coverage extends to injuries resulting from participation in a racing event overseas as many policies specifically exclude coverage for racing injuries and/or injuries occurring overseas (outside of the coverage territory). CO-DRIVER/RIDER - MEDICAL INSURANCE CARRIER: POLICY NUMBER: 3 12/20/10

4 SECTION 3 Not Applicable MOTORCYCLE / QUAD / SIDECAR 4 12/20/10

5 SECTION 4 RACE ENTRY INFORMATION VINTAGE DIVISION Vintage Division Automobiles will be evaluated for eligibility based on the information provided. Classifications are described on the RMVR web site. Safety requirements are described on the PPIHC and RMVR web sites. CHASSIS Year: Make: Model: Wheel base (inches): Wet Weight (lbs): BODY Year: Make: Model: ENGINE Year: Make: Induction: Heads: Displacement (cc): Fuel type: Octane: 2-cycle (y/n): Overhead cam (y/n): Rotary (y/n): Turbo/supercharger (y/n): TRANSMISSION Year: Make: Model: # Forward gears: DIFFERENTIAL Year: Make: Model: Car number. There will be no duplicate numbers. Numbers are on a first come basis. Letters are not considered part of the number (eg. 6ST and 6e and 6 are the same number). Numbers must be 3 digits or less. Please refer to the 2011 PPIHC rule book. First choice: Second choice: Third choice: Verified accurate and correct Driver/entrant

6 SECTION 5 RACING HISTORY - If you have not raced Pikes Peak before, please be very detailed about your previous racing experience. Please list the history from most recent to oldest. Race Officials will be using that information to determine whether or not to accept your entry. If this is your first time racing in this historic event, you will be considered a Rookie regardless of your past racing history. Your attendance at our Rookie School is mandatory. Competition Licenses and Racing history other than Pikes Peak. (Do not reference previous applications) Racing history on Pikes Peak. (Do not reference previous applications) 6

7 SECTION 6 SPONSORS / MEDIA INFORMATION / PHOTOGRAPHS / RACE WEEK LOCATIONS SPONSOR INFORMATION (limited to four) Sponsor 1 Sponsor 2 Sponsor 3 Sponsor 4 Media Information - for possible use on web site and or the program. Information must be received prior to May 01, Photographs - Each entry must be accompanied by two (2" X 2" minimum) current color facial photographs of the driver, rider, or co-driver or rider, and one of the race vehicle. Photographs received after April 1, 2010 will not be included in the program. Where will you be staying during Race Week? Where will your competition vehicle be during Race Week? 7 12/20/10

8 SECTION 7 PAYMENT INFORMATION Entrants must qualify with Vintage Division Automobiles eligibility posted on the RMVR web site: Vintage Division Automobiles Entry Fees Early Entry prior to February 1, 2011 $900 Standard Entry Feb. 1 through March 31, 2011 $1,000 Late Entry, from April 1 to deadline June 1, 2011 $1,100 Incomplete entry forms lacking information will not be considered until all information has been received by RMVR. Entry includes fee for the Saturday June 25, 2011 Vintage Car and Motorcycle Show in Manitou Springs, Colorado. The Vintage Division Automobiles rebate program applies. More entries mean more money back. For more information go to The rebate will range from approximately $100 up depending on the number and timing of the entries received. Fifteen entries starts the rebate program. The maximum number of Vintage Division entries that will be accepted will be 25. Rebate checks will be handed out to each entry at registration. Entry Packet and Entry Fees (must be paid by check) and mailed prior to the deadline to (make checks payable to RMVR): RMVR PPIHC Vintage Division Automobiles c/o Rob VanWestenberg 8245 Wagon Wheel Road Morrison, CO For more information, contact the race chairman: Arthur Porter awpesq@comcast.net Telephone: /20/10