Charity Cruise Entry Application

Charity Cruise Entry Application

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

With this registration you are to PAY IN FULL: $1500.00. Entries close April 30th 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