TRE/Trial Online Entry Form

= required

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