Nominations

IMPORTANT: Please read before completing your entry form.

A payment link will be found in the email that is sent to you once the form below has been completed. You also need to download and complete this Self-Scrutiny Checklist.

Autocross or Motorkhana Entry Form

Competitor/Driver Information

COMPETITOR

(Car Owner)

Autocross or Motorkhana?

Autocross Motorkhana

Select Race Date or Event

First Name

Last Name

Email Address

Address Line 1

Address Line 2

Postcode

Date of birth

Phone

Emergency Contact Name

Emergency Contact Phone

FIRST DRIVER

First Driver First Name

First Driver Last Name

First Driver Email Address

First Driver Address Line 1

First Driver Address Line 2

First Driver Postcode

First Driver Date of birth

First Driver Phone

First Driver SWTCC Membership No

First Driver CAMS Licence

Next of Kin

Next of Kin Contact Phone

SECOND DRIVER

Second Driver First Name

Second Driver Last Name

Second Driver Email Address

Second Driver Address Line 1

Second Driver Address Line 2

Second Driver Postcode

Second Driver Date of birth

Second Driver Phone

Second Driver SWTCC Membership No

Second Driver CAMS Licence

Next of Kin

Next of Kin Contact Phone

THIRD DRIVER

Third Driver First Name

Third Driver Last Name

Third Driver Email Address

Third Driver Address Line 1

Third Driver Address Line 2

Third Driver Postcode

Third Driver Date of birth

Third Driver Phone

Third Driver SWTCC Membership No

Third Driver CAMS Licence

Next of Kin

Next of Kin Contact Phone

DESCRIPTION OF CAR

Make

Model/Year

Colour

Agreement

By ticking this check box, all persons on this entry form agree to read and adhere to the risk warning, disclaimer and indemnity that will be emailed to your upon receipt of this entry form. You also certify that all entries on this form are members with the South West Touring Car Club (Inc.). All parties agree to be bound by the constitution and rules of the South West Touring Car Club (Inc.). INSURANCE INFORMATION: As from July 1st 1990 Personal Accident Insurance is automatically covered under the organising permit for the event.

Comments / Questions

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Committee

President:
Jason Lowther 0407 658 609

Vice President:
Kelsey Gerdei 0418 917 228

Secretary:
Jenny Gerdei 0412 799 806
Email Jenny

Treasurer:
Sharon Johnson 0427 378 867
Email Sharon

Autocross Secretary:
Adam Wright 0437 617 385

Motorkhana Contact:
Brendan Hansen 0407 984 322

Track Manager:
Graeme Miles 0418 939 002

Nominations

Autocross or Motorkhana Entry Form

COMPETITOR

FIRST DRIVER

SECOND DRIVER

THIRD DRIVER

DESCRIPTION OF CAR

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Committee