2019 Solo Contingency Claim Form

Competitors must be officially registered each year to participate in the program prior to competing. No awards will be paid if you are not enrolled prior to competing. Photos must be taken onsite at the event selected on this form; we suggest doing this while waiting in impound. Additionally, competitors must complete and submit this Contingency Claim Form onsite at each eligible event before they leave the competition site at the end of the event.

Finishing positions will be verified by the SCCA National Staff and awards will be made to legal finishers only. Payment is issued by SCCA within 30 days of claim receipt.

Applicant Applying for Contingency

Member Number

Select which sponsor you qualify to submit a claim.

Photos of vehicles must be taken in impound at the event selected on this form.

Full side view of vehicle showing all required decals and tires.

Full Front view of vehicle showing all required decals.

Full side view of vehicle showing all required decals and tires.

I hereby acknowledge that these photos were taken at the event which I am submitting a contingency claim for.

I understand and agree to the conditions of the contingency program(s) and acknowledge that I have never been compensated for the above claim.

IGNORE FIELD - FOR OFFICIAL USE ONLY