Rally/Display Registration Form – Sept. 6, 2008 – EAA Silicon Valley 

Amount ______  Display ____   Rally ____  

Paid on ________   Cash ____ Check ____   PayPal ____   

I will need charging at the event:    Before ____      After ______

The kind of charging/connection I’ll need is ______________________________


I hereby absolve the Electric Auto Association (EAA), all officers of the EAA, rally officials, and any city or corporation permitting use of its property for conducting the rally, of any responsibility for problems, accidents, or damages caused or created as a result of my participation in the rally. It is my responsibility to abide by the California Motor Vehicle Code.


Name_______________________________________	
			
Home telephone_____________________________

Cell phone ________________________________

Address ___________________________________

Email _____________________________________

Car license # _____________________________

Insurance Company _________________________

I have read and agree to the rules ________ (initial)
			
Mail check (payable to EAA) and form to: EAASV, 1864 Catherine St., Santa Clara, CA, 95050. Payment can also be made via PayPal (bank transfer only, no credit cards) and in person the day of EV Rally. Please email form to eaasv@yahoo.com by August 31 so it will be ready on Rally day. Email eaasv@yahoo.com for PayPal instructions.



Model _______________________________________ Year  ________________  

Production model ____________ Conversion ______________   

First year electric _____________________

Converted by _____________________________________________________

Curb weight ___________ Weight after conversion __________ 

Hours to convert ______________

Time to charge __________ 	KWh to charge _____________ 	 

Cost to charge _______________

Range _________   		Top speed ________ 		

No. of drive batteries ______	Type of batteries ____________ 

Battery mfr _____________________

Other details 
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