(WA) red dirt extreme rigs entry form and sup regs

773 Views 4 Replies 2 Participants Last post by mal/dan, Feb 3, 2011

ashbilt

Discussion Starter · Feb 2, 2011

Driver Details

Name:———————————————————————————————————
ADDRESS:—————————————————————————————————
PHONE NUMBER——————————————————————————————
EMAIL ADDRESS——————————————————————————————
EMERGENCY CONTACT DETAILS——————————————————————-

VEHICLE DETAILS

(include: make, model, engine size, vehicle class)
__________________________________________________
__________________________________________________________________________
__________________________________________________________________________

CO-DRIVER DETAILS:

NAME:——————————————————————————————————
ADDRESS:—————————————————————————————————
PHONE NUMBER——————————————————————————————
EMAIL ADDRESS——————————————————————————————
EMERGENCY CONTACT DETAILS——————————————————————-

PIT CREW DETAILS

Name:———————————————————————————————————
Name:———————————————————————————————————

Cost of Entry

: $450per vehicle, to be paid in full and accompany your entry form
Entry forms must be received no later than March 22nd 2011 . Late entries will not be accepted
To Enter a Murchison Offroad Adventures event, you must sign a waiver form. You do not
need to be a member of the ccda, insurance will be supplied by MOA, the cost of which will be
covered in your entry fee. Full terms and conditions of entry are available in the supplementary
regulations.
Withdrawl from the event must be received in writing 28 days prior to the start of the event.
After this time no refunds will be given for any withdrawals or failure to attend for any reason

SIGNATURE:———————————————————————————————

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