Oregon Rally Group - TSD Road Rally

Oregon 1000 - Signup

Please fill out the following form:

Driver Info:

Name:

Street Address:

City, State Zip:

Drivers License
(State, Number,
& Expiration Date):

Email:

Phone:

ORG/SCCA Member:

Region:

Member#:

Navigator Info:

Name:

Street Address:

City, State Zip:

Email:

Phone:

ORG/SCCA Member:

Region:

Member#:

Will any minors be attending with you?

Car Info:

Make:

Model:

Year:

Color:

Car License#:

Car Licensed State:

Does either competitor own this vehicle:

Vehicle HAM radio equipped:

Driver Callsign:

Navigator Callsign:

Class:

Entry Fees:

ORG/SCCA Members $195.00

Mixed Team (1 Member/1 Non) $200.00

Non-members $210.00

Make check payable to: Oregon Rally Group
Mail check to
Kevin Poirier - Oregon 1000
70640 Nick Thomas Road
Rainier, OR 97048

At event check in you will need to attest that the above entered vehicle is on the road legally, is being used by the entrant with the owner’s permission, and is covered by liability insurance of not less than $20,000/$40,000/$10,000, or the minimum requirements of the state of registry, whichever is higher.

For more information contact orgtsd@yahoo.com

j-and-b