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2010 Vw Club Claim


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2010 Vw Club Claim

  1. 1. 2010 VOLKSWAGEN OF AMERICA SCCA CLUB RACING CONTINGENCY PROGRAM CLAIM FORM REGISTRATION: Competitors must be officially registered to participate in the program before the date of the event in which you will be competing. No awards will be paid if you are not enrolled prior to competing in an eligible event. Additionally, competitors must complete and submit this Claim Form no later than 30 days after each eligible event, and submit one W-9 form to the SCCA prior to distribution of posted awards each year. REQUIREMENTS: Must compete with a VW body and engine (exception: VW powered FA and FV competitors). Vehicles must display a Volkswagen windshield banner and VW decals on each side of the vehicle. Decals are available upon request from Jennifer McAbee at SCCA: or (800) 770-2055. VERIFICATION and AWARD PAYMENT: Decal placements must be verified on-site by a tech official - who must sign this claim form. Claim forms may be signed to verify decals placements prior to the posting of Official Results. Completed claim forms must be submitted with a copy of the Official Race Results and will be verified upon receipt. Finishing positions will be verified by the SCCA National Staff; awards will be made to legal finishers only. Payment is issued by SCCA within 30 days of claim receipt. NAME: ____________________________________________ SOCIAL SECURITY # OR TAX ID #: (circle one) ADDRESS: ________________________________________ _________________________________________________ CITY: _____________________________________________ EVENT LOCATION: ________________________________ STATE: __________________ ZIP: ____________________ EVENT DATE: ____________________________________ DAY PHONE: ______________________________________ FINISH POSITION: ________________________________ E-MAIL: ___________________________________________ CLASS: ___________________ CAR # ________________ SCCA MEMBER #: __________________________________ CAR MODEL: ____________________ CAR YEAR: ______ Award Payouts are presented for 1st, 2nd and 3rd finishes in Club Racing National competition and 1st place finishes in Club Information: Racing Regional competition. A minimum number of competitors are required to be eligible for awards. 3 competitors = 1st and 2nd awards only; 2 competitors = 1st place award only. Volkswagen will also award $1,000 to year-end divisional champions in each eligible class. (Only National competitors per section 3.9.1 of the GCR.) PAYOUT SCHEDULE 1st 2nd 3rd Regional: FP, HP, GTL, FA, FV, ITS, ITA, ITB, ITC $150 National: SSC, T3, STU $1500 $1000 $500 National: HP, GT2, GT3, GTL $500 $300 $200 National: FP, FV $200 $150 $100 By signing below, I understand and agree to the conditions of the Volkswagen Contingency program and acknowledge that I have never been compensated for the above claim. DRIVER/CAR OWNER SIGNATURE DATE The required product use and/or decal placement of this competitor has been verified on-site by: POST-RACE TECH OFFICIAL SIGNATURE SCCA MEMBER NUMBER DATE SUBMIT TO: SPORTS CAR CLUB OF AMERICA Attn: Contingency Claims Please copy this form as needed for submission of P.O. Box 19400 additional claims. Signatures may not be copied. Topeka, KS 66619 FAX: (785) 232-7228