Nominations

Autocross or Motorkhana? Autocross or Motorkhana? Autocross Motorkhana

Select Race Date or Event Select Race Date or EventTest and Tune MarchMotorkhana AprilRound One - 8th MayRound Two - 26th JuneRound Three - 7th AugustRound Four - 4th SeptemberRound Five - 8th OctoberRound Six - 5th NovemberMotorkhana November

First Name

Last Name

Email Address

Address

Suburb

Postcode

Date of Birth

Phone

Emergency Contact Name

Emergency Contact Phone

Driver 1: First Name

Last Name

Address

Suburb

Postcode

Date of Birth

Phone

SWTCC Membership No

CAMS Licence No

Next of Kin

Next of Kin Phone

Driver 2: First Name

Last Name

Address

Suburb

Postcode

Date of Birth

Phone

SWTCC Membership No

CAMS Licence No

Next of Kin

Next of Kin PHone

Driver 3: First Name

Last Name

Address

Suburb

Postcode

Date of Birth

Phone

SWTCC Membership No

CAMS Licence No

Next of Kin

Next of Kin Phone

Car Make and Colour

Car Model/Year

Agreement 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