OFFICIAL ENTRY FORM  

The Search for The Great Pumpkin 

October 2, 2004

 Driver          _____________________________________________________ Navigator____________________________________________________

Street          _____________________________________________________  Street ________________________________________________________

City/State        ______________________________________ Zip _______      City/State __________________________________________ Zip_______

Telephone  (____)  _____________                                          Telephone     (____) ______________

e-Mail ____________________________________________________           e-Mail __________________________________________________________    

Emergency Contact _______________________________________           Emergency Contact _____________________________________________

    Relationship ____________                  Telephone (____) ___________                Relationship ____________                  Telephone (____) __________

Member of:    SCCA ______ TCNE ______                                                     Member of:    SCCA ______  TCNE ______

Class:          A__________B__________C__________S__________D__________                        

 Vehicle: Year, Make, and Model ________________________________   Color_____________ Registration Plate _____________State ____________

VEHICLE TECHNICAL INSPECTION:  Within 24 hours prior to the start of The Search (10/2/2004, 8:11 a.m.), the entered vehicle shall be self-inspected by its driver and/or navigator, and shall meet the required equipment standards set forth in the Safety Inspection Checklist (available at Registration).   The standards include those specified in the 1996 NER/SCCA Road Rally Regulations (Amended), Article I-3, Section A, 1. – 7. (Page 7), plus a spare tire.   The completed and signed Checklist shall be presented to the Registrar at Registration.     

This event will be conducted in accordance with the 1996 NER/SCCA Road Rally Regulations (Amended). The entrant warrants that an auto insurance policy with liability limits of not less than $20,000/$40,000/$10,000, or the minimum requirements of the state of registry, whichever is higher, is in force for the vehicle entered.  Also, said vehicle is in safe operating condition for the state in which it is registered.  In signing this form, we agree to abide by all the regulations and decisions of the rally committee.

All minors, under 18 years of age, must present a completed Minor Release and Waiver of Liability and Indemnity Agreement, MS-2A,   at registration.   MS-2A  forms are available upon request from the Registrar.   MS-2A agreements must be signed by BOTH parents or legal guardians.  Both signatures must be witnessed by an ADULT SCCA member or a notary public,  when executed away from an event.   MS-2A agreements may be signed at an event, and BOTH signatures witnessed at registration by an ADULT SCCA member.

Driver's signature:___________________________                Navigator’s signature:_______________________________

Entry Fee Enclosed: $_____________  (SCCA or TCNE members by Sept. 15, 2004,  $32.  Non-members and late entry, $42.)

                  Mail completed Entry Form and check for Entry Fee                                   Mary Beth Folsom, Registrar

                  [payable to New England Region, SCCA, Inc.]                                                212 Castlewood Drive

                   to the Registrar after September 1, 2004.                                                     Bloomfield, CT  06002-1370      (860) 243-8557