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TRE/Trial Online Entry Form
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Email:
TRE ROUND 4 - WILD DOG FLAT RALLYSPRINT
Sunday, 24th November 2019
CAMS Permit # - 519/2411/03
COMPETITOR/CAR OWNER DETAILS
Competitor First Name
Competitor Surname
Competitor Address
Competitor Suburb/Town
Competitor State
- select -
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Competitor Postcode
Competitor Mobile Tel. #
Competitor Home Tel. #
Competitor Work Tel. #
Competitor Email
Competitor CAMS Licence #
Competitor CAMS Licence Expiry
DRIVER DETAILS
Is the Driver the same as the Competitor/Car Owner?
Yes
No
Driver First Name
Driver Surname
Driver Address
Driver Suburb/Town
Driver State
- select -
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Driver Postcode
Driver Mobile Tel. #
Driver Home Tel. #
Driver Work Tel. #
Driver Email
Driver Grade
Driver Civil Licence #
SEAC Membership #
Driver CAMS Licence #
Driver CAMS Licence Expiry
Driver CAMS Licence Type
Emergency Contact Name
Emergency Contact Mobile #
Supplementary Regulations
I have read and understand the Supplementary Regulations.
Disclaimer
I have read, understood, acknowledge and agree to the risk warning disclaimer and indemnity document, including the exclusion of statutory guarantees, warning, assumption of risk, release and indemnity.
CO-DRIVER DETAILS
Co-Driver First Name
Co-Driver Surname
Co-Driver Address
Co-Driver Suburb/Town
Co-Driver State
- select -
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Co-Driver Postcode
Co-Driver Mobile Tel. #
Co-Driver Home Tel. #
Co-Driver Work Tel. #
Co-Driver Email
Co-Driver Grade
Co-Driver Civil Licence #
Co-Driver SEAC Membership #
Co-Driver CAMS Licence #
Co-Driver CAMS Licence Type
Co-Driver CAMS Licence Expiry
Co-Driver Emergency Contact Name
Co-Driver Emergency Contact Mobile #
Supplementary Regulations
I have read and understand the Supplementary Regulations.
Disclaimer
I have read, understood, acknowledge and agree to the risk warning disclaimer and indemnity document, including the exclusion of statutory guarantees, warning, assumption of risk, release and indemnity.
VEHICLE DETAILS
Vehicle Make
Vehicle Model
Vehicle Colour
Vehicle Year of Manufacture
Vehicle Registration #
If applicable.
Vehicle Registration Expiry
If applicable.
Engine Capacity (CCs)
Please enter a 4-digit number.
Turbo
Yes
No
Supercharge
Yes
No
Drive Type
2WD
4WD
Does the Vehicle have a Log Book?
Yes
No
CAMS Log Book #
Vehicle Class
A - <1300 2WD
B - 1301-1600 2WD
C - 1601-2000 2WD
D - >2001 2WD
E - 4WD
FEES
Payment Method
EFT
Cheque
Money Order
Cash
SUBMIT ENTRY
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