Official Use Only
Entry #________________
Ck _________________
Amt $_______________
July 4-7, 2013 -- Seattle, Washington Reg
Sht
.
2013W
2013 West Coast
Lotus Meet
Early Bird Registration ends March 18, 2013 --- LAST Day to Register – June 23, 2013
2013 West Coast Lotus Meet REGISTRATION
Name #1 ____________________________________
Name #2 ____________________________________
Address _____________________________________
Name #3 ____________________________________
City, State ___________________________________
Address _____________________________________
Country, Postal Code __________________________
City, State ___________________________________
Day Ph _____________________________________
Country, Postal Code __________________________
Ev Ph ______________________________________
Day Ph _____________________________________
Email _______________________________________
Ev Ph _______________________________________
Lotus Model ____________________ Yr ___________
Email _______________________________________
Shirt size (circle) XXL
Shirt size (circle) XXL
XL
L
M
S
XL
L
M
S
Registration includes – Thursday Reception, WCLM memento and Welcoming Dinner, Tour of the Flying Heritage Collection,
Friday, Saturday and Sunday Drives, an Autocross, Friday and Saturday Lunches, Friday dinner, Saturday attendance at
Vintage/Historic Races, a banquet and tour of LeMay - America's Car Museum, Sunday Lotus-only Car Show, BBQ lunch,
Awards & much more.
Are you planning to attend:
Optional WCLM High-Performance Driving Day ______
WCLM Autocross (July 5, 2013)
______
Pre-WCLM Dinner in Portland (July 3, 2012) ______
Post-WCLM Activities in British Columbia (July 8) ______
Early Bird – register before March 18, 2013
Qty _____ X $225 (club member*) = __________
Qty _____ X $250 (non member) = __________
Standard Registration – March 5 to June 4, 2013
Qty _____ X $250 (club member*) = __________
Qty _____ X $275 (non member) = __________
Standard Registration – June 5 to June 23, 2013
Qty _____ X $325 (club member*) = __________
Qty _____ X $350 (non member) = __________
*Member: Any current member or guest of a member of the ELCC, GGLC or partner Lotus club
No walk-up Registrations. Last day to register is June 23, 2013
WCLM Misc. Items
Additional WCLM Shirts (Note sizes & gender) _______________
Qty __________ X $40 = ______________
Registration deadline June 23, 2013 - No on-site registration
Full Entry Fee payment must accompany this completed form. Make checks payable to Golden Gate Lotus Club.
Shirt size and availability cannot be guaranteed for registrations after May 15, 2013
Make Checks to:
Golden Gate Lotus Club
TOTAL ENCLOSED: $ ______________
Mail to:
775 Paul Ave.
Palo Alto, CA 94306
WCLM Contact Information
2013 WCLM Chair - Doug Jackson
Hm: (206) 300-9130 - [email protected]
Kiyoshi Hamai (GGLC)
[email protected]
The 2013 West Coast Lotus Meet is presented by the Evergreen Lotus Car Club in partnership with the Golden Gate Lotus Club, Club Elite,
Club Lotus Northwest, Southern Nevada Lotus Car Club and Lotus Owners of Phoenix
2013 West Coast Lotus Meet
July 4-7, 2013 -- Seattle, Washington
WAIVER and RELEASE (must be signed by every participant and returned with WCLM entry & entry fees)
In consideration of being permitted to enter the 2013 West Coast Lotus Meet, or being permitted to compete, officiate, observe, work
for, or for any purpose participate in any way in the event, the undersigned, for himself, his personal representatives, heirs and next of kin
acknowledges, agrees and represents that he has, or will immediately upon entering any of such restricted area or areas and his participation,
if any, in the event constitutes an acknowledgement that he has inspected such restricted area and that he finds and accepts the same as
being safe and reasonably suited for the purposes of his use, and he further agrees and warrants that if, at any time, he is in or about
restricted areas and he feels anything to be unsafe, he will immediately advise the officials of such and will leave the restricted area.
1. Hereby release, waives, discharges and covenants not to sue the Golden Gate Lotus Club, Inc. (GGLC), GGLC officers, the
Evergreen Lotus Car Club (ELCC), ELCC officers, the promoter(s), participants, racing association, sanctioning organization(s) and
subdivision thereof, track operator, track owner, officials, car owners, drivers, pit crews, any persons in any restricted area,
promoters, sponsors, advertisers, owners and lessees or premises used to conduct the event and each of them, their officials and
employees, all for the purposes herein referred to as “releasees”, from all liability to the undersigned, his personal representatives,
assigns, heirs, and next of kin for any and all loss or damage, and any claim or demands therefore on account of injury to the person
or property or resulting in death of the undersigned, whether caused by the negligence or the releasees or otherwise while in the
undersigned is in or upon the restricted area, and/or, competing, officiating, observing, working for, or for any purpose participating
in the event.
2. Hereby agrees to indemnify and save and hold harmless the releasees and each of them form any loss, liability, damage, or cost
they may incur due to the presence of the undersigned in or upon the restricted area or in any way competing, officiating, observing,
or working for, or for any purpose participating in the event and whether caused by the negligence of the releasees or otherwise.
3. Hereby assumes full responsibility for and risk of bodily injury, death, or property damage due to the negligence of releasees or
otherwise while in or upon the restricted areas and/or while competing, officiating, observing or for any other purpose participating in
the event.
The undersigned expressly acknowledges and aggress that the activities of the event can be very dangerous and involve the risk of
serious injury and/or death and/or property damage. The undersigned further expressly agrees that the foregoing release, waiver and
indemnity agreement is intended to be as broad and inclusive as is permitted by the laws of the State of Washington and that if any portion
thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
The undersigned agrees that they will be a member of the Golden Gate Lotus Club, Inc. for the duration of the event and will abide by the
by laws and rules of the Golden Gate Lotus Club.
The undersigned has read and voluntarily signs the release and waiver of liability and indemnity agreement, and further agrees that no
oral representations, statements or inducements apart from the foregoing written agreement have been made.
______________________________________________________________________________
Print Name
Signature
Date
_________________________________________________________________________________
Print Name
Signature
Date
Hotel Information
The WCLM has reserved a block of rooms at the headquarters of the
2013 WCLM. These spaces will be held through June 13, 2013.
Contact the Red Lion Inn directly and mention the WCLM or
Evergreen Lotus Car Club for the special rates.
Red Lion Inn
11211 Main Street
Bellevue, WA 98004
Tel: (425) 455-5240
WCLM participants are not required to stay at the Red Lion Inn and
are responsible for making their own lodging arrangements.
WCLM Contact Information
2013 WCLM Chair
Doug Jackson
Hm: (206) 300-9130
[email protected]
Kiyoshi Hamai (GGLC)
[email protected]
The 2013 West Coast Lotus Meet is presented by the Evergreen Lotus Car Club in partnership with the Golden
Gate Lotus Club, Club Elite, Club Lotus Northwest, Southern Nevada Lotus Car Club and Lotus Owners of
Phoenix
Rev: 4-24-2013