2017 ford performance nasa contingency program ... AWS
2017 FORD PERFORMANCE NASA CONTINGENCY PROGRAM CLAIM FORM REGISTRATION: Competitors must be officially registered to participate in this program with both NASA and Ford Performance 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. Additionally, competitors must complete and submit this Claim Form no later than 30 days after the event after each eligible event. DECAL REQUIREMENTS: All competitors must display four Ford Performance decals – Ford Blue Oval on each side of the car and Ford Performance decal on each side of the car. The required decals are provided upon registration with Ford Performance Parts. Additional decals are available by contacting Carrie Nolan at Ford Performance – [email protected]
VERIFICATION/AWARD PAYMENT: Product use and decal placements must be verified on-site by a tech official - who must sign this claim form. Claim forms may be signed to verify decal placements and product use 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 NASA Staff; awards will be made to legal finishers only. Payment will be issued by Ford Performance within approximately 45 days of claim receipt. DRIVER NAME:_____________________________________
EVENT LOCATION:_________________________________
ADDRESS: _________________________________
EVENT DATE:_____________________________________
CITY:______________________________________ STATE:_____________ZIP:____________________
FINISH POSITION:_________________________________
DAY PHONE:____________________________________
CLASS: __________________ CAR # ___________
EMAIL:____________________________________
STARTERS_________________________________
NASA MEMBER # ___________________________
CAR MAKE / MODEL / YEAR: ___________________________________________
AWARDS PAID TO:________________________________________
S.S # or Tax I.D: __________________________________________
By signing below, I understand and agree to the conditions of the Ford Performance Contingency program and acknowledge that I have never been compensated for the above claim.
_____________________________________________________________________________________________ DRIVER/CAR OWNER SIGNATURE DATE The required product use and decal placement of this competitor has been verified on-site in post-race tech by:
_____________________________________________________________________________________________ TECH OFFICIAL SIGNATURE NASA MEMBER NUMBER DATE SUBMIT TO: Upload online or email
[email protected] 510-221-4007 Fax: 510-277-0657 Please copy this form as needed for submission of additional claims. Signatures may not be copied.
NASA (11 Regional Point Standings) American Iron (AI) American Iron Extreme (AIX) SI (regional races only) 3+ Starters / 2 Starters B-Spec Performance Touring (PT) Super Touring (ST) Super Unlimited (SU) NASA Championships
Championship
1st $1,000 $1,000 $250 / $100 $1,000 $1,000 $1,000 $1,000 $2,500
2nd $750 $750 $200 / $50 $750 $750 $750 $750 $1,000
3rd $500 $500 $50 / 0 $500 $500 $500 $500 $750
VERIFICATION/AWARD PAYMENT: Product use and decal placements must be verified on-site by a tech official - who must sign this claim form. Claim forms may be signed to verify decal placements and product use 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 NASA Staff; awards will be made to legal finishers only. Payment will be issued by Ford Performance within approximately 45 days of claim receipt. DRIVER NAME:_____________________________________
EVENT LOCATION:_________________________________
ADDRESS: _________________________________
EVENT DATE:_____________________________________
CITY:______________________________________ STATE:_____________ZIP:____________________
FINISH POSITION:_________________________________
DAY PHONE:____________________________________
CLASS: __________________ CAR # ___________
EMAIL:____________________________________
STARTERS_________________________________
NASA MEMBER # ___________________________
CAR MAKE / MODEL / YEAR: ___________________________________________
AWARDS PAID TO:________________________________________
S.S # or Tax I.D: __________________________________________
By signing below, I understand and agree to the conditions of the Ford Performance Contingency program and acknowledge that I have never been compensated for the above claim.
_____________________________________________________________________________________________ DRIVER/CAR OWNER SIGNATURE DATE The required product use and decal placement of this competitor has been verified on-site in post-race tech by:
_____________________________________________________________________________________________ TECH OFFICIAL SIGNATURE NASA MEMBER NUMBER DATE SUBMIT TO: Upload online or email
[email protected] 510-221-4007 Fax: 510-277-0657 Please copy this form as needed for submission of additional claims. Signatures may not be copied.
NASA (11 Regional Point Standings) American Iron (AI) American Iron Extreme (AIX) SI (regional races only) 3+ Starters / 2 Starters B-Spec Performance Touring (PT) Super Touring (ST) Super Unlimited (SU) NASA Championships
Championship
1st $1,000 $1,000 $250 / $100 $1,000 $1,000 $1,000 $1,000 $2,500
2nd $750 $750 $200 / $50 $750 $750 $750 $750 $1,000
3rd $500 $500 $50 / 0 $500 $500 $500 $500 $750
