World Human Powered Speed Challenge
Battle Mountain, Nevada USA
September 14 - 19, 2015
Name(s)_____________________________________________________________________________________
Name of vehicle/ team_________________________________________________________________________
Address___________________________________________________________________________________
Telephone____________________Fax____________________Cell____________________________________
Email________________________________Website_______________________________________________
Emergency Contact Name and Cell Number_______________________________________________________
Description of vehicle_________________________________________________________________________
__________________________________________________________________________________________
Builder(s)__________________________________________________________________________________
Rider (s) Name, age, sex________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
New vehicle? Yes___No___ New rider? Yes___No___ Years attending _____MPH Hat earned ________
Current member IHPVA?  Yes___No___Don't Know__Current member ABR?  Yes__No__Don't Know___
All riders, builder/ owners, team advisor /manager must be a current IHPVA member.
ABR membership and insurance for riders only. Memberships run from 12 months from application date. 
Please fill out membership forms (IHPVA & ABR) for each new member. All riders must fill out and sign ABR form
Fees:
Single entry 1 rider :  300.00___(includes 1 free T-shirt & poster ) Size: S_M_L_XL_Men/ Women  Total________ 
Additional rider(s) X  100.00____(includes 1 free poster per rider)                                                        Total________ 
T-shirt(s)____ X 20.00=_____   # Men’s____ # Women’s                                                                 Total_________                                                                                                                                                   
Size (how many each size): S___ M___L___XL___ (Larger sizes by request add 2.00)
Poster(s)___ X 3.00                                                                                                                             Total________ 
IHPVA Membership: US/Canada ___X 32.00___ all other countries____X  37.00                            Total_________                                              
ABR Membership:____X  25.00  Junior:(under18)____X 10.00 Senior: (over 80)____X  Free          Total________ 
Insurance_____ X 20. 00                                                                                                                    Total________
Early Registration deduction: (1 per application)                                                                                         -25.00 
                                                                                                                                                   Balance due_________
Applications received by August 20, 2015 get 25.00 discount.                                                                                                                                                  
Do not mail application after Aug 25, 2015. Emailed forms OK until Sept 10, 2015 
Cancellation after September 1, 2015 will result in the loss of all fees.
fax, mail or email this application, make checks payable to:
IHPVA                                                                          Card # _______________________________________
2338 18th St Eureka, CA 95501                                  Expiration Date________Security code_______Zip Code_________
Ph 707-443-8261 fax 707-444-2579                            Name on Card____________________________________
email:  a.krause@sbcglobal.net                                   Signature_______________________________________
                                                                                     email for reciept:_______________________________________