TRE/Trial Online Entry Form

= required

TRE ROUND 4 - BURRUNGULE BASH

Saturday, 14th September 2019

CAMS Permit # - 519/1409/01

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.

NAVIGATOR DETAILS

Navigator First Name
Navigator Surname
Navigator Address
Navigator Suburb/Town
Navigator State	- select - Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia
Navigator Postcode
Navigator Mobile Tel. #
Navigator Home Tel. #
Navigator Work Tel. #
Navigator Email
Navigator Grade
Navigator Civil Licence #
Navigator SEAC Membership #
Navigator CAMS Licence #
Navigator CAMS Licence Type
Navigator CAMS Licence Expiry
Navigator Emergency Contact Name
Navigator 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