Charity Cruise Entry Application

Charity Cruise Entry Application

Application Date
Your Email Address
DRIVERS, RIDERS INFORMATION
Full Name
Date of Birth
Residential Address
Mobile Phone
Emergency Contact Name
Emergency Contact Phone
CO DRIVERS, PILLION PASSENGER INFORMATION:
Full Name
Date of Birth
Residential Address
Mobile Phone
Emergency Contact Name
Emergency Contact Phone
CAR BIKE DETAILS
Car, Bike Make
Car, Bike Model & Year
Car, Bike Registration Number
ACCOMMODATION REQUIREMENTS:
Double or Twin
Special Meal Requirements
MESSAGE
REGISTRATION PAYMENT:

You can choose to PAY IN FULL: $1500.00 or Pay a Deposit of $300 with the balance of $1200.00 to be paid prior to March 15th 2018

Registration Payment: Direct Deposit: Please Use your Surname for Payment Reference:

BSB: 082760
Account No: 369082739
Account Name: OZ SHOW CARS

By clicking on the SUBMIT BUTTON you hereby acknowledge that you have read and agree to the Terms & Conditions of being a participant in the Charity Cruise