1. 2010 VOLKSWAGEN OF AMERICA
SCCA CLUB RACING CONTINGENCY PROGRAM
CLAIM FORM
REGISTRATION: Competitors must be officially registered to participate in the program 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 in an eligible event. Additionally, competitors must complete
and submit this Claim Form no later than 30 days after each eligible event, and submit one W-9 form to the SCCA prior to distribution of
posted awards each year.
REQUIREMENTS: Must compete with a VW body and engine (exception: VW powered FA and FV competitors). Vehicles must display a
Volkswagen windshield banner and VW decals on each side of the vehicle. Decals are available upon request from Jennifer McAbee at
SCCA: jmcabee@scca.com or (800) 770-2055.
VERIFICATION and AWARD PAYMENT: Decal placements must be verified on-site by a tech official - who must sign this claim form.
Claim forms may be signed to verify decals placements 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 SCCA National Staff;
awards will be made to legal finishers only. Payment is issued by SCCA within 30 days of claim receipt.
NAME: ____________________________________________ SOCIAL SECURITY # OR TAX ID #: (circle one)
ADDRESS: ________________________________________ _________________________________________________
CITY: _____________________________________________ EVENT LOCATION: ________________________________
STATE: __________________ ZIP: ____________________ EVENT DATE: ____________________________________
DAY PHONE: ______________________________________ FINISH POSITION: ________________________________
E-MAIL: ___________________________________________ CLASS: ___________________ CAR # ________________
SCCA MEMBER #: __________________________________ CAR MODEL: ____________________ CAR YEAR: ______
Award Payouts are presented for 1st, 2nd and 3rd finishes in Club Racing National competition and 1st place finishes in Club
Information: Racing Regional competition.
A minimum number of competitors are required to be eligible for awards.
3 competitors = 1st and 2nd awards only; 2 competitors = 1st place award only.
Volkswagen will also award $1,000 to year-end divisional champions in each eligible class. (Only National competitors
per section 3.9.1 of the GCR.)
PAYOUT SCHEDULE 1st 2nd 3rd
Regional: FP, HP, GTL, FA, FV, ITS, ITA, ITB, ITC $150
National: SSC, T3, STU $1500 $1000 $500
National: HP, GT2, GT3, GTL $500 $300 $200
National: FP, FV $200 $150 $100
By signing below, I understand and agree to the conditions of the Volkswagen Contingency program and acknowledge that I have never
been compensated for the above claim.
DRIVER/CAR OWNER SIGNATURE DATE
The required product use and/or decal placement of this competitor has been verified on-site by:
POST-RACE TECH OFFICIAL SIGNATURE SCCA MEMBER NUMBER DATE
SUBMIT TO: SPORTS CAR CLUB OF AMERICA
Attn: Contingency Claims
Please copy this form as needed for submission of
P.O. Box 19400
additional claims. Signatures may not be copied.
Topeka, KS 66619
FAX: (785) 232-7228