2019 Subaru Rally Tasmania Entry Form

1
Is the Competitor/Entrant the Same as the Driver?* This field is required
YESNO
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2
Entry Transaction ID
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3
Competitor Name* This field is required
First Name
Last Name
Email Address
Mobile Number
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4
Competitor Address* This field is required
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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5
Entry Details - Driver* This field is required
First Name
Last Name
Email Address
Mobile Number
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Enter
6
Driver Address* This field is required
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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7
CAMS Licence Type
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8
Driver CAMS Licence Number
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Enter
9
Driver CAMS Licence Expiry
Date
Year
Month
Day
Date
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10
Driver Civil Licence Number
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Enter
11
Driver Civil Licence Expiry
Date
Year
Month
Day
Date
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12
Driver Next of Kin
Name
Relationship
Mobile Number
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Enter
13
Entry Details - Co Driver* This field is required
First Name
Last Name
Email Address
Mobile Number
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Enter
14
Co Driver Address* This field is required
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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15
CAMS Licence Type
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16
Co Driver CAMS Licence Number
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Enter
17
Co Driver CAMS Licence Expiry
Date
Year
Month
Day
Date
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18
Does the Co Driver have a Current Civil Drivers Licence
YESNO
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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)
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20
Co Driver Civil Licence Number
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21
Co Driver Civil Licence Expiry
Date
Year
Month
Day
Date
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Enter
22
Co Driver Next of Kin
Name
Relationship
Mobile Number
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23
All Correspondence to* This field is required
DriverCo Driver
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24
Sponsor Name(s)
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25
Team Manager
First Name
Last Name
Email Address
Mobile Number
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26
Competition Vehicle Details* This field is required
Make
Model
Year
Colour
Registration Number
Registration Expiry
Engine Number
Chassis Number
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27
Vehicle Colour and Signwriting* This field is required
Base Colour
Signwriting and other colours
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28
Competition Category DetailsChoose one or many categories below
TRC / ARC / National / International Category
ARC / National /International Class
TRC Class
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29
Will you be testing* This field is required
YESNO
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30
Testing Details
Select 1
Will you be testing with another competitor
Please specify Other Competitor / Driver / Team (if applicable)
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31
Do you plan on Reconnaissance for this event* This field is required
YESNO
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32
Please indicate which Reconnaissance Session you will attend* This field is requiredNOTE: 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
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33
Reconnaissance Vehicle Details* This field is requiredPlease 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
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34
Will you be utilising another competitors service crew* This field is required(you won't be bringing your own service crew)
YESNO
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35
Please specify Other Competitor / Driver / Team* This field is required
Press
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36
Service Crew Chief
First Name
Last Name
Email Address
Mobile Number
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Enter
37
Will you have multiple Service Vehicles?* This field is required
YESNO
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Enter
38
Service Vehicle 1* This field is required
Make
Model
Registration Number
Colour
Length in Metres
Width in Metres
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Enter
39
Add another service vehiclePlease note that all additional service vehicles will incur an additional charge
YESNO
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Enter
40
Service Vehicle 2
Make
Model
Registration Number
Colour
Length in Metres
Width in Metres
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41
Add another service vehiclePlease note that all additional service vehicles will incur an additional charge
YESNO
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Enter
42
Service Vehicle 3
Make
Model
Registration Number
Colour
Length in Metres
Width in Metres
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Enter
43
Add another service vehiclePlease note that all additional service vehicles will incur an additional charge
YESNO
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44
Service Vehicle 4
Make
Model
Registration Number
Colour
Length in Metres
Width in Metres
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Enter
45
Service Crew MembersDetail for crew members 1 to 4
Name
Mobile Number
Name
Mobile Number
Name
Mobile Number
Name
Mobile Number
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46
Add additional Service Crew Members
YESNO
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Enter
47
Service Crew MembersDetail for crew members 5 to 8
Name
Mobile Number
Name
Mobile Number
Name
Mobile Number
Name
Mobile Number
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Enter
48
Add additional Service Crew MembersPlease not that more that 8 service crew will incur an additional charge
YESNO
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49
Service Crew MembersDetail for crew members 9 to 12
Name
Mobile Number
Name
Mobile Number
Name
Mobile Number
Name
Mobile Number
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Enter
50
Would you like to upload any documentation items now* This field is requiredThese items must be presented at documentation, however you can upload now to save you time later
YESNO
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51
Document Upload (Optional)
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Browse Files
Cancelof
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52
How would you like to pay?* This field is requiredPlease note that PayPal and Credit Card incur a 2.6% surcharge
EFTPayPal
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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)
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54
Your EFT entry calculation total is $Please EFT this total to: BSB 302-162 Acct 1219048
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55
PayPalPlease note that PayPal will incur a 2.6% surcharge
My Bag
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My Bag
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$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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$20
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Size:Small
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ORDER SUMMARY
Total costAUD
Cross Entered ARC / Pacific Cup Entry
$1,539.00AUD+Remove
Back
Pacific Cup Entry
$1,539.00AUD+Remove
Back
ARC Entry
$1,539.00AUD+Remove
Back
Home State Cross Entered ARC / TRC Entry
$1,539.00AUD+Remove
Back
TRC Entry
$923.40AUD+Remove
Back
Testing - Half Day
$513.00AUD+Remove
Back
Testing - Full Day
$1,026.00AUD+Remove
Back
Additional Road Book
$56.50AUD+Remove
Back
1
Quantity
Subtotal: $0.00AUD
Additional Service Crew (each)
$102.60AUD+Remove
Back
1
Quantity
Subtotal: $0.00AUD
Total $0.00AUD
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56
This form was submitted by* This field is requiredDetails of the person submitting the form
First Name
Last Name
Please enter your email
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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.
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