Please print out, fill in and return to HERO

 ENTRY APPLICATION FORM
for

Classic Reliability Trial 4x4 Adventure Drive
   1st driver  2nd driver

Surname

 

 

 

 

 

(Mr/Mrs/Miss/Ms - delete as applicable)

 

 

 

 


(Mr/Mrs/Miss/Ms - delete as applicable)

Usual first name    
Age (if 25 or under)    
Nationality    

Postal address

 

 

   

Telephone: work

home

Fax

e-mail

   

Relevant experience

 

 

   

Next of kin: name

Address/tel/fax

   

OTHER CREW MEMBERS

 No 3: Surname  Usual 1st name   Age
 No 4: Surname  Usual 1st name   Age

 VEHICLE (if you do not yet have all of the information required, write "TBA"; * delete as applicable)

Make
__________________________		 Model and body type
______________________________
No of seats
_____________		 Year made
____________		 Engine type (petrol, diesel, turbo-diesel, etc)
______________________________
Engine size
______________cc		 Registration no ______________ International letter(s) of country of registration (GB, NL, etc) ______
Dimensions:      
 length
___________ metres		  height
_________ metres
(roofrack fitted/removed*)		  Laden weight __________ kg width
_____ ______metres
For Classic Reliability Trial:
Year made
__________		 Launch year of this variant ___________ Age Category/Class applied for
___________

Modifications from standard (NB: all significant modifications must be declared; use separate sheet if necessary):

TEAM ENTRY (Classic Reliability Trial only - you may be in one team of each kind):

Name of team Other team members

National Team __________________________  1
_____________________		  2
____________________
Marque Team ________________________ 1
_____________________		 2
____________________
Club/ecurie Team ________________________  1
_____________________		 2
____________________

APPLICATION FOR ENTRY: We, the undersigned, apply to enter the 2001 INCA TRAIL CLASSIC RELIABILITY TRIAL or the 2001 INCA TRAIL 4x4 ADVENTURE DRIVE, as indicated at the head of this Entry Form. We have read and understood the Regulations for this event and agree to be bound by them and by such new or amended Regulations and instructions as may from time to time be issued. We understand that if this application is accepted there will be an immediate legally binding contract with the Organisers incorporating this application and all such Regulations. I the undersigned being the first driver undertake to make the payments indicated below and understand that I have a personal liability to pay the entry fee under such Regulations and in default we the undersigned being the other signatories understand that we are jointly and severally liable. We the undersigned agree to indemnify and hold harmless the Organisers and officials of the event, the Fédération Internationale de l'Automobile, the Motor Sports Association, and all other companies bodies and individuals associated with or participating in the event (and their respective employees and agents) against all proceedings, damages, liabilities, costs and expenses arising out of any act, default, negligence or breach of statutory duty on our part. We declare that the vehicle entered will be covered by insurance for third party liability as required by law while driven by any member of its crew during any part of the event held on the public highway. We undertake to abide by the laws of each country visited in the course of the event.

1st driver: signature: _______________________________________ Date ____________________

2nd driver: signature: _______________________________________ Date ___________________

3rd crew member: signature: _________________________________ Date ___________________

4th crew member: signature: _________________________________ Date ___________________

ENTRY FEES (this section to be completed by those applying to do full event only; others, see below)

Sum payable: 1. Vehicle fee
(Reliability Trial £11,500, Adventure Drive £8,500):		 £ ______________
  2. Crew fees
( ______ persons x £5,525):		 £ ______________
3. Single room supplement
( _____ persons @ £2,750 per person)
(£5,500 per 2-person crew)
 £ ______________
  3. Team fee(s)
( _____ teams of 3 cars x £150 per team):		 £ ______________
  Less discount of _____% for early booking
(see below)		 £ ______________
 
NET TOTAL of all fees payable		 £ ______________

PAYMENT OPTION - tick box(es) as applicable:

FULL FEE WITH DISCOUNTS NOW: I enclose
a sterling cheque a copy of my transfer order to my bank
for immediate payment of the full fee, less early payment discount applicable at this date, as follows:
full fee paid on or before 31.12.2000, 2.5% discount

INSTALMENT PLAN: I wish to pay by the instalments shown below:

Before 31 July 1999 £2,500
Before 31 January 2000 a further £2,500 - total now due £5,000
Before 31 July 2000 a further £2,500 - total now due £7,500
Before 31 January 2001 a further £5,000 - total now due £12,500
On 30 June 2001 balance of full fee

I enclose a sterling cheque for the sum due at today’s date and I undertake to pay the remaining instalments on the dates they fall due, as above; I understand that my entry may be cancelled, and sums paid forfeited, if I fail to maintain the above schedule of payments

I enclose a copy of my completed banker’s order form, ordering my bank to make the appropriate payments on the above dates

APPLICANTS FOR RIO - VIÑA DEL MAR OR VIÑA DEL MAR - RIO ONLY: this application must be accompanied by a deposit of £1,000 sterling. This will be refunded if the application cannot be accepted at the entry list opening date of 1 October 2000.

All cheques must be in stering, made payable to Historic Endurance Rallying Organisation - HERO
Our bank account details are:
Lloyds Bank plc, 48 Belle Vue Terrace, Malvern, Worcester, WR14 4QG, UK
Branch sort code: 30-95-41; account name: Historic Endurance Rallying Organisation - HERO a/c; number: 0921536

Return this form to
The Inca Trail 2001
Classic Reliability Trial and 4x4 Adventure Drive
The Town House, Leigh, Worcester, WR6 5LA, England

Last modified 09 November 2000