2023 Mitta Mountain Rally Entry Form

1. Entry Details (Competitor/Entrant)
Is the Competitor/Entrant the Same as the Driver?*

YesNo
Competitor Name
Please Note: if the owner of the vehicle is not the Driver of the Vehicle then a 'MA Automobile Legal Drivers Declaration' is required to be presented.

Download Form Here
2. Entry Details (Driver)
Driver Name*
Date of Birth (Driver)
**NOTE: ONLY APPLICABLE FOR 'MASTERS and VCRS' ENTRIES
Civil Licence*

Licence NoExpiry Date
Motorsport Australia Licence*

Licence NoExpiry Date
Grade **NOTE: only applicable for VCRS Competitors

BCDEF
Request Registration for VCRS Junior Cup?

Yes
Request Registration for VCRS Senior Cup?

Yes
Car Club

Club NameMember NoExpiry Date
Mobile*
E-mail*
Address

Street Address

Street Address Line 2

CityState

Post Code
Next of Kin*

NameMobileRelationship
3. Entry Details (Co Driver)
Co Driver Name*
Date of Birth (Co Driver)
**NOTE: ONLY APPLICABLE FOR 'VCRS' ENTRIES
Civil Licence

Licence NoExpiry Date
Motorsport Australia Licence

Licence NoExpiry Date
Grade **NOTE: only applicable for VCRS Competitors

BCDEF
Request Registration for VCRS Junior Cup?

Yes
Request Registration for VCRS Senior Cup?

Yes
Car Club

Club NameMember NoExpiry Date
Mobile
E-mail
Address

Street Address

Street Address Line 2

CityState

Post Code
Next of Kin*

NameMobileRelationship
Sponsor Name
4. Competition Vehicle Details
Vehicle*

MakeModelYearEngine cc
Registration NoExpiry Date
Engine NoChassis NoLog Book No
Turbo
FWD/RWD/4WD
5. Competition Details
Event*
ECCRS Points - *Please note that VRC & Masters, NSWRC & Masters and Masters entries are automatically eligible to score ECCRS points.
VRC Points - *Please note: it is assumed that both crew members wish to score points in 2021 VRC unless one of following options is selected*

Driver does NOT wish to score VRC pointsCo Driver does NOT wish to score VRC points
NSWRC Points *Please note that NSWRC entries not wishing to score NSWRC points must enter "Open" Class.
VCRS Points - *Please note: it is assumed that both crew members wish to score points in 2021 VRC unless one of following options is selected*

Driver does NOT wish to score VCRS pointsCo Driver does NOT wish to score VCRS points
Class

VRC PRC/GpN - PN1 up to 1400cc (also VCRS A)VRC PRC/GpN - PN2 1401 - 1600cc (also VCRS B)VRC PRC/GpN - PN3 1601 - 2000cc (also VCRS C)VRC PRC/GpN - PN4 2000cc + 2WD (also VCRS D)VRC PRC/GpN - PN5 2000cc + 4WD - not P6 (inc GpN (P) (also VCRS E)VRC PRC/GpN - PN6 2000cc + 4WD pre '98 (GC8/Evo 6.5 Mech Diffs) (also VCRS E)NSWRC 2WD up to 1600cc (Pocket Rocket)NSWRC 2WD 1601 - 2000ccNSWRC 2WD 2001cc and overG4 - MA Group G4G2 - MA Group G2AP4 - MA Group AP4S2000 - FIA S2000S1600 - FIA Group S1600 *Not eligible for VRC points or awardsR5 - FIA Group R5 *Not eligible for VRC or NSWRC points or AwardsCLB - Club Rally CarCLB+30 - Club Rally Cars over 30 years oldHRC - Historic Rally CarC1 - Classic Rally CarC2 - Classic Rally CarC3 - Classic Rally CarC4 - Classic Rally CarOpen - Vehicle complying with Schedule A but none of above classes
**Please Note: Entries in VRC and Masters or NSWRC and Masters must select a Classic Rally Car Class as well as a VRC PRC/GpN or NSW 2WD class if applicable.
We have registered for Victorian Excel Rally Series

Yes
6. Service Vehicle and Crew Information
Service Vehicle #1

MakeModelRegistration
Contact NameContact Number
Service Vehicle #2

MakeModelRegistration
Contact NameContact Number
Service Crew Member #1

First & Last NameMobile Number
Service Crew Member #2

First & Last NameMobile Number
Service Crew Member #3

First & Last NameMobile Number
Service Crew Member #4

First & Last NameMobile Number
Service Crew Member #5

First & Last NameMobile Number
Service Crew Member #6

First & Last NameMobile Number
7. Entry Fees
Options*
prevnext( X )
VRC & NSWRC Early Entry Fee until 8th February 2023 at 2000hrs$750.00AUD

VRC & NSWRC Standard Entry Fee after 8th February 2023 until close of entries$800.00AUD

Masters Early Entry Fee until 8th February 2023 at 2000hrs$650.00AUD

Masters Standard Entry Fee after 8th February 2023 until close of entries$700.00AUD

VCRS Early Entry Fee until 8th February 2023 at 2000hrs$550.00AUD

VCRS Standard Entry Fee after 8th February 2023 until close of entries$600.00AUD
8. Entry Fee Payment
Entry fee payment is by EFT only to the following account:

BSB: 633 000

ACC: 187899471

*In the payment description field, the three letter event code “MMR” is to be entered followed by the "Competitors First initial-Surname” e.g.: MMR T-Jones. A copy of the EFT transaction receipt is to be emailed to entries@mittamountainrally.com
9. Book-In
For more efficient Book In at the event, the following documentation can be uploaded before submitting an entry. If you do not upload it here before entry submitted, please e-mail to entries@mittamountainrally.com or bring with you to book in;

Entry Disclaimer (download here )

MA Self Scrutiny Check list (download here)

MA Self Scrutiny Statement of Vehicle Compliance (download here)

MA regional "Scrutineer's Report - Rally and Road"

MA Licences

Civil Licences

Club Licences

Vehicle Registration

Declaration of Co-Driver without Civil Licence (download here)
UPLOAD your documents BEFORE Submitting your Entry

Upload a File

Cancelof
Should be Empty:

Now create your own Jotform - It's free!Create your own Jotform

1. Entry Details (Competitor/Entrant)

2. Entry Details (Driver)

3. Entry Details (Co Driver)

4. Competition Vehicle Details

5. Competition Details

6. Service Vehicle and Crew Information

7. Entry Fees

8. Entry Fee Payment

9. Book-In