Alpine 4x4 Challenge Support Crew Online Registration Form
19th - 22nd September, 2008
As well as completing this form, you will need to print and complete the
Credit Card Debit Form
and fax it to 03 9723 2022 or send either the Credit Card Debit Form or a cheque (made out for $160 per person in the support crew) to:
Australian 4wd Events
PO Box 330,
Croydon Vic 3136
Cheques are to be made payable to Australian 4wd Events
* Compulsory Field
Support Crew Member #1
Support Crew Member #2
*Name:
*Name:
*Address:
*Address:
*Postcode:
*Postcode:
*State:
*State:
*Ph (Home):
*Ph (Home):
*Ph (Work):
*Ph (Work):
*Ph (Mob):
*Ph (Mob):
*Email:
*Email:
*Age:
*Age:
*D.O.B. (dd/mm/yy):
*D.O.B. (dd/mm/yy):
*Club:
*Club:
Support Crew Member #3
Support Crew Member #4
*Name:
*Name:
*Address:
*Address:
*Postcode:
*Postcode:
*State:
*State:
*Ph (Home):
*Ph (Home):
*Ph (Work):
*Ph (Work):
*Ph (Mob):
*Ph (Mob):
*Email:
*Email:
*Age:
*Age:
*D.O.B. (dd/mm/yy):
*D.O.B. (dd/mm/yy):
*Club:
*Club:
Name/s of competitors in your team (must be completed):
*Name:
*Name:
Vehicle Information
What 4wd do you plan to use for the support vehicle?
*Make:
*Model:
*Registration:
*Engine and fuel type:
Super
Unleaded
Diesel
I would like to receive regular updates via email on the Outback 4x4 Challenge and the Alpine 4x4 Challenge events (un-tick the box if you would not like to register for this service). You can unsubscribe from this service at any time and your details will be kept strictly confidential.
After completing all of the fields in this form and submitting it to us we will need to receive your payment of $160 per person in your support crew. This can be done by either cheque or credit card and must be done before your application will be considered.
Send a cheque or a completed
Credit Card Debit Form
for $160 per person to:
Australian 4wd Events
PO Box 330,
Croydon Vic 3136
Cheques are to be made payable to Australian 4wd Events
Alternatively, the Credit Card Debit Form can be faxed to 03 9723 2022
To follow up on this entry application or for more information please feel free to
contact us
.
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