Navigation Assembly - Event Entry Form

Address

Address

Address

Next of Kin *

Name Mobile Relationship
4. Vehicle Details
Vehicle *

Make Model Year
Registration

Registration No Expiry Date
5. Entry Fees
Options *

Navigation Assembly Entry Fee $ 80.00 AUD

Total $ 0.00 AUD
6. Payment Options
Payment via? *

EFT Cheque/Money Order PayPal / Credit Card
Payment Via EFT;

BSB: 067-003

ACC: 28063934

Account Name: 500 Car Club of Tasmania

*please use Drivers surname as the reference
Payment via cheque/Money Order;

All cheques and money orders should be made out to the 500 Car Club of Tasmania

170 Nierinna Road

MARGATE 7054
Payment via PayPal / Credit Card;

Pease click HERE to complete your payment

(After Payment, don't forget to return to this TAB to complete your entry!)
7. Form Submission

Details of the person submitting the form
Submitted by *

First Name Last Name
Submitter Email *
example@example.com
Security Check *
Should be Empty:

7. Form Submission