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2019 SCCA CLUB CONTINGENCY REDEMPTION FORM

REGISTRATION: Competitors must be officially registered to participate in the program prior to competing. No awards will be paid if you are not enrolled prior to competing. It is the competitor’s responsibility to register properly and neatly apply decals.

REQUIREMENTS: Competitor must run Carbotech Brakes. All competitors must display three Carbotech Brakes, LLC decals – one on the front
and one on each side of the car. (Exception: Formula cars may run one on the center of the nose or one on each side of the car).

COMPLIANCE AND AWARD PAYMENT: Decals placement must be verified on-site by SCCA Scrutineer prior to posting the Official Results.
Completed claim forms must be submitted with a copy of the Official Race Results and will be verified upon receipt. Awards will be made to
legal finishers only. Payment will be issued by Carbotech Brakes within 30 days of claim receipt.

All contingency awards must be claimed no later than 30 days after the award was earned. Requests received after this date will be denied.

I, and for good valuable consideration, hereby authorize Carbotech Brakes, LLC. to utilize my name
and/or statements and/or photographs of myself and/or my car in any/all publicity, and/or sales and/or promotional activities. I
am claiming contingency awards for the following event:

Track: _________________

Date: _________________

Class: _________________

Finish Position: ____________

Compliance Checklist

Carbotech Decals on front and both sides of car: YES / NO

SCCA Scrutineer - Impound Sign:

Scrutineer Member #:

Driver's Signature:

After typing in the information above, print off a copy of this completed form and send it, along with official race results, to:
Carbotech Brakes LLC · 6111 Carey Drive Ste. 6 · Cleveland, OH 44125. Or fax (216-642-8504) or e-mail to: darla@ctbrakes.com