Download Entry Form Here

or

Please fill out the attached form:

Driver:______________________________________________________________________________Age:______________
Vehicle (make/model:______________________________________________________Year:_______________
Address:____________________________________________________________________________
City:_______________________________________________________________________________ State:_______________ Zip:_______________
Contact Info Email:_______________________________________________________________________________Phone:______________________________________________________________________________
Emergency Contact Info ( Name + phone number )____________________________________________

___________________________________________________________________________________Navigator/Co-Driver:____________________________________________________________________ Age:____________

Address:____________________________________________________________________________
City:________________________________________________________________________________ State:___________ Zip:_______________
Contact Info

Email:_______________________________________________________________________________
Phone:______________________________________________________________________________
Emergency Contact Info ( Name + phone number )_____________________________________________

___________________________________________________________________________________
Special Notes:________________________________________________________________________
___________________________________________________________________________________

Rally Information:
Liability Release: I declare that I understand that the Bohemian Run is a self guided tour taking place on public roads and all posted speed limits are applicable, and that my vehicle is registered and insured and I possess a valid Drivers License. Furthermore I acknowledge that driving a car is inherently dangerous, and injury/and or death may occur as a result. I also pledge to indemnify and hold harmless: Pete Petras, The Bohemian Run and any of their agents as to any claims that may result from my participation in this event.
Driver Signature:_______________________________________________Date:_________________________
Navigator/Co-Driver Signature:_______________________________________________Date:_________________________

 

Note all entries/accommodation are for 2 participants, no discounts for single driver

[  ]  Entry Fee $375 (entry must be received before October 15th, 2015

[  ]  Late Entry $425 (entries received after October16th, 2015

 

Driver T-shirt size:_________ Co-driver/Navigator T-shirt size:_________

Send check payable to Pete Petras to:
1748 Monticello Rd, San Mateo, CA 94402

 

 

Download Entry Form Here