2017 HPD NASA Regional Championship Claim Form
Rebate Award Application – Regional Championship (HPD Honda Challenge Series)
DRIVERS NAME: ADDRESS: CITY, STATE & ZIP CODE: PHONE NUMBER SOCIAL SECURITY #: HRL MEMBERSHIP NUMBER: EMAIL ADDRESS: RACE INFORMATION – Limit one award per competitor per year. RACE CLASS: REGION: MAKE & MODEL OF CAR: VERIFICATION for DISPLAY OF HPD DECALS TECHNICAL OFFICIAL NAME (Printed): SIGNATURE: 2 “HPD” decals and windshield banner (Official’s Initials): REGIONAL CHAMPIONSHIP RACE RESULTS TOTAL NUMBER OF CLASSIFIED COMPETITORS: FINISHING POSITION AND “CASH” AWARD AMOUNT 5 Competitors: 1st = $500
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Awards are non-transferable. Only winning competitor can claim and receive the award. Regional Championship cash awards are only available to those who competed in the Honda Challenge National Championship race weekend. To qualify for this award, there must be at least 5 competitors listed in your class in the regional championship results. Contingency Claim forms must be submitted within 30 days from when official results are posted for each eligible event. “HPD Bucks” expire 180 days after submitting claim forms. Submit completed form at https://www.nasaproracing.com/contingencies. Official Use Date Received by NASA:__________________
DRIVERS NAME: ADDRESS: CITY, STATE & ZIP CODE: PHONE NUMBER SOCIAL SECURITY #: HRL MEMBERSHIP NUMBER: EMAIL ADDRESS: RACE INFORMATION – Limit one award per competitor per year. RACE CLASS: REGION: MAKE & MODEL OF CAR: VERIFICATION for DISPLAY OF HPD DECALS TECHNICAL OFFICIAL NAME (Printed): SIGNATURE: 2 “HPD” decals and windshield banner (Official’s Initials): REGIONAL CHAMPIONSHIP RACE RESULTS TOTAL NUMBER OF CLASSIFIED COMPETITORS: FINISHING POSITION AND “CASH” AWARD AMOUNT 5 Competitors: 1st = $500
• • • • • •
Awards are non-transferable. Only winning competitor can claim and receive the award. Regional Championship cash awards are only available to those who competed in the Honda Challenge National Championship race weekend. To qualify for this award, there must be at least 5 competitors listed in your class in the regional championship results. Contingency Claim forms must be submitted within 30 days from when official results are posted for each eligible event. “HPD Bucks” expire 180 days after submitting claim forms. Submit completed form at https://www.nasaproracing.com/contingencies. Official Use Date Received by NASA:__________________
