RallyTas - 2019 Subaru Rally Tasmania Entry Form

1

Is the Competitor/Entrant the Same as the Driver?* This field is required.

YESNO

2

Entry Transaction ID

3

Competitor Name* This field is required.

First Name

Last Name

Email Address

Mobile Number

4

Competitor Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

5

Entry Details - Driver* This field is required.

First Name

Last Name

Email Address

Mobile Number

6

Driver Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

7

CAMS Licence Type

8

Driver CAMS Licence Number

9

Driver CAMS Licence Expiry

Date

10

Driver Civil Licence Number

11

Driver Civil Licence Expiry

Date

12

Driver Next of Kin

Name

Relationship

Mobile Number

13

Entry Details - Co Driver* This field is required.

First Name

Last Name

Email Address

Mobile Number

14

Co Driver Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

15

CAMS Licence Type

16

Co Driver CAMS Licence Number

17

Co Driver CAMS Licence Expiry

Date

18

Does the Co Driver have a Current Civil Drivers Licence

YESNO

19

If the Co Driver does not have a valid or current Civil Drivers Licence, please download and complete this declaration and present at the time of documentation. (Right Click and Save As)

20

Co Driver Civil Licence Number

21

Co Driver Civil Licence Expiry

Date

22

Co Driver Next of Kin

Name

Relationship

Mobile Number

23

All Correspondence to* This field is required.

DriverCo Driver

24

Sponsor Name(s)

25

Team Manager

First Name

Last Name

Email Address

Mobile Number

26

Competition Vehicle Details* This field is required.

Make

Model

Year

Colour

Registration Number

Registration Expiry

Engine Number

Chassis Number

27

Vehicle Colour and Signwriting* This field is required.

Base Colour

Signwriting and other colours

28

Competition Category DetailsChoose one or many categories below

TRC / ARC / National / International Category

ARC / National /International Class

TRC Class

29

Will you be testing* This field is required.

YESNO

30

Testing Details

Select 1

Will you be testing with another competitor

Please specify Other Competitor / Driver / Team (if applicable)

31

Do you plan on Reconnaissance for this event* This field is required.

YESNO

32

Please indicate which Reconnaissance Session you will attend* This field is required.NOTE: You may only complete two (2) passes over each competitive stage in total. These sessions can be completed over different Reconnaissance Sessions

Saturday 15th June

Sunday 16th June

Thursday 20th June

33

Reconnaissance Vehicle Details* This field is required.Please Note: Tyres used for recce are to have a maximum groove width of and depth of 8mm and no other opening in the tread may be greater than 10mm (worn rally tyres are not to be used). Tyres marked M+S having a non-aggressive tread pattern may be used, but only after a written application by a competitor has been approved by the Clerk of Course or his representative. Tyres shown on the previously approved FIA list of recce tyres for Rally Australia are also allowed. Penalties apply for exceeding the 60km speed limit during reconnaissance.In the event that a reconnaissance vehicle breaks down and is replaced, competitors must contact the Secretariat via the next Stage Official and provide details of the replacement reconnaissance vehicle.

Make

Model

Colour

Rego

34

Will you be utilising another competitors service crew* This field is required.(you won't be bringing your own service crew)

YESNO

35

Please specify Other Competitor / Driver / Team* This field is required.

36

Service Crew Chief

First Name

Last Name

Email Address

Mobile Number

37

Will you have multiple Service Vehicles?* This field is required.

YESNO

38

Service Vehicle 1* This field is required.

Make

Model

Registration Number

Colour

Length in Metres

Width in Metres

39

Add another service vehiclePlease note that all additional service vehicles will incur an additional charge

YESNO

40

Service Vehicle 2

Make

Model

Registration Number

Colour

Length in Metres

Width in Metres

41

Add another service vehiclePlease note that all additional service vehicles will incur an additional charge

YESNO

42

Service Vehicle 3

Make

Model

Registration Number

Colour

Length in Metres

Width in Metres

43

Add another service vehiclePlease note that all additional service vehicles will incur an additional charge

YESNO

44

Service Vehicle 4

Make

Model

Registration Number

Colour

Length in Metres

Width in Metres

45

Service Crew MembersDetail for crew members 1 to 4

Name

Mobile Number

Name

Mobile Number

Name

Mobile Number

Name

Mobile Number

46

Add additional Service Crew Members

YESNO

47

Service Crew MembersDetail for crew members 5 to 8

Name

Mobile Number

Name

Mobile Number

Name

Mobile Number

Name

Mobile Number

48

Add additional Service Crew MembersPlease not that more that 8 service crew will incur an additional charge

YESNO

49

Service Crew MembersDetail for crew members 9 to 12

Name

Mobile Number

Name

Mobile Number

Name

Mobile Number

Name

Mobile Number

50

Would you like to upload any documentation items now* This field is required.These items must be presented at documentation, however you can upload now to save you time later

YESNO

51

Document Upload (Optional)

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

52

How would you like to pay?* This field is required.Please note that PayPal and Credit Card incur a 2.6% surcharge

EFTPayPal

53

EFT Entry Items* This field is required.

Pacific Cup Entry ($1,500)

ARC Entry ($1,500)

TRC Entry ($900)

Cross Entered ARC / Pacific Cup ($1,500)

Cross Entered Home State ARC / TRC ($1,500)

Testing Half Day ($500)

Testing Full Day ($1,000)

Additional Road Book each ($50)

Additional Service Crew each ($100)

54

Your EFT entry calculation total is $Please EFT this total to: BSB 302-162 Acct 1219048

55

PayPalPlease note that PayPal will incur a 2.6% surcharge

My Bag

0

Cross Entered ARC / Pacific Cup Entry
$1,539.00AUDEdit
Back
Pacific Cup Entry
$1,539.00AUDEdit
Back
ARC Entry
$1,539.00AUDEdit
Back
Home State Cross Entered ARC / TRC Entry
$1,539.00AUDEdit
Back
TRC Entry
$923.40AUDEdit
Back
Testing - Half Day
$513.00AUDEdit
Back
Testing - Full Day
$1,026.00AUDEdit
Back
Additional Road Book
$56.50AUDEdit
Back
1
1
2
3
4
5
Quantity
Additional Service Crew (each)
$102.60AUDEdit
Back
1
1
2
3
4
Quantity

56

This form was submitted by* This field is required.Details of the person submitting the form

First Name

Last Name

Please enter your email

57

Thank you for your entry to the 2019 Subaru Rally Tasmania!

As we draw closer to the event, we will update you with any bulletins and further information as it comes to hand.