iRace

Independent Race Series

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Please complete all details for your entry.

By submitting this form, you indicate agreement with the:

Driver's Declaration and Disclaimer

Click to read the contents.

Persons under 18 years of age will require parent or guardian consent (this must be signed by the parent/guardian on the hardcopy form).

All items marked with a * are required for your form to be submitted. If you are unsure, or waiting on any of the other details, please input "TBA" in the relevant box.

Round Four Entry Form
Lakeside - 12-13 June 2010

First Name * Enter the competitor's first name.

Surname * Enter the competitor's surname.

Preferred Race Number (1st choice) * Enter your first option for preferred race number.

Preferred Race Number (2nd choice) * Enter your second option for preferred race number.

Preferred Race Number (3rd choice) * Enter your third option for preferred race number.

Category Entered * Select the category you are competing in.

Competitor/Entrant Phone Number (BH) Business Hours contact number for the competitor/entrant.

Competitor/Entrant Mobile Number Mobile contact number for the competitor/entrant.

Competitor/Entrant Fax Number Fax number for the competitor/entrant.

Competitor/Entrant Address Address for the competitor/entrant.

Competitor/Entrant Email Address * Email address for the competitor/entrant.

Sponsor (1) Your sponsor.

Sponsor (2) Your sponsor.

Driver First Name * Enter the driver's first name.

Driver Surname * Enter the driver's surname.

Driver Competition Licence Number * Enter the driver's licence number.

Driver Competition Licence Type * Enter licence type: iRace, CAMS, AASA, etc

Driver Phone Number (BH) Business hours contact number for the driver (this may be a mobile number).

Driver Fax Number Fax number for the driver.

Driver Date of Birth * Driver Date of Birth: DD-MM-YYYY

Driver Address * Enter the driver's address.

Driver Email Address Enter the driver's email address.

Driver Emergency Contact * Enter the name of the driver's emergency contact.

Driver Emergency Contact Phone Number * Enter the contact number for the driver's emergency contact.

Vehicle Make * Enter the competition vehicle make.

Vehicle Year/Model * Enter the competition vehicle year and/or model.

Vehicle Colour Enter the competition vehicle colour(s).

Vehicle Capacity * Enter the competition vehicle capacity in cc.

Vehicle Logbook Number * Enter the iRace Logbook Number for the competition vehicle.

Vehicle Dorian Number * Enter the Dorian transmitter number.

Garage Booking: I require the following * Enter your choice of garage.

One Carport (+$0 - free for first 50 paid entrants))
No garage required (+$0)

Acknowledgement * I acknowledge that I have read and agree with the driver's declaration/disclaimer, and that I agree to sign a printed copy of this entry at the event.

Payment Type * Enter your intended method of payment. Entry fee is $395 plus any additional for the garage option you have selected.

Credit Card (Mastercard or Visa)
PayPal
Cheque/Money Order