2021 "Rallye for a Cure" Registration Form
This year's event is Saturday, May 15th. We will begin at our host, New Country BMW, and head up to Palmer Motorsports Park for lunch and parade laps on the track! Get your team together, and plan to have some SAFE fun while raising money for a GREAT cause! Please complete the following information for your team. Payment options are at the end of this form.
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Email *
Driver First Name *
Driver Last Name *
Street Address *
City *
State *
Zip Code *
Cell Phone Number *
Navigator First and Last Name *
Team Name *
Vehicle Make *
Vehicle Model *
Vehicle Year *
Vehicle Color *
Choose the Special Class that BEST describes your team *
* If you are coming as part of a Friends & Family Team, please list the other cars' team names here:
How did you hear about the "Rallye for a Cure?" (Please list specific Car Club, email, friend, Instagram, Facebook, website, etc.) *
Terms and Conditions of Entry: I agree with the following terms and conditions: 1. The entry fee, as stated herein, is for one vehicle entered in the "Rallye for A Cure" to support JDRF. Owner/entrant understands that this entry is a conditional offer to participate and if accepted, constitutes an agreement with the "Rallye for a Cure" coordinators to take part in the "Rallye for a Cure" unless otherwise prevented by circumstances beyond the control of owner/entrant. A "yes" response is on behalf of owner/entrant's team and promises that all participants will comply with federal, state, and local laws related in any way to the event. 2. A "yes" response further certifies that all information on this form is true and correct, and that licenses and insurance policies are and will be legally valid and in force throughout the duration of the event. 3. A "yes" response also shows acknowledgement that all participating crew and support members must agree to permit the "Rallye for a Cure," 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.:* *
Required
Two lunches are included in admission price for the Driver and Navigator. Please purchase a lunch ($15) for EACH additional passenger. All lunches come with chips and a drink.
2 Hot Dogs
Quarter Pound Cheeseburger
Grilled Chicken Sandwich with Choice of Sauce
Large Chicken Caesar salad
Vegetarian Wrap
Driver Lunch
Navigator Lunch
1st Additional Passenger
2nd Additional Passenger
3rd Additional Passenger
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