ENTRY00a.DOC                                           FILE NUMBER - (OFFICIAL USE ONLY):

 

PO BOX 34-469 - BIRKENHEAD - AUCKLAND  fax (09) 418 51 81

Email:   series@tops.co.nz

 

PLEASE FILL IN AND RETURN TO ABOVE ADDRESS WITH A CHEQUE FOR $30 MADE OUT TO "BRC".  Acceptance entitles you to the end of season dinner - value $35!

 

INFORMATION SUPPLIED MAY BE STORED IN A DATABASE USED SPECIFICALLY FOR MOTORSPORT USE AND WILL NOT BE DISCLOSED TO ANY COMMERCIAL ORGANISATION.

 

Issue of this form does not  bind the organisers to accept the application.

 

	FIRST	SURNAME
NAME:
FULL POSTAL
ADDRESS

                                                                                                                                  

HOME PHONE	FAX	WORK PHONE	EMAIL

Where FAX number is supplied, please state whether (H) or (Work)

 

CAR & OTHER DETAILS REQUIRED - see over and complete  --->

 

MAKE		MODEL
CAR CLUB		SAL/GT/SPORTS
cc		YEAR
COLOUR(S)		ROAD REG'N No
COMP LIC No:		EXPIRES:
LOG BOOK No:		ID CERTIFICATE
PREFERRED RACE No:		2nd choice:

 

I hereby apply to the Organising Committee for Series registration and if accepted, I agree to abide by the Articles and Rules of the Series as published and the spirit of Classic Racing.  I acknowledge the organising committee's right to refuse entry to the series or cancel the invitation at a later date given just cause.

signature:

 Please also fill in page 2  as partially filled in forms will not be accepted. Preferred series race numbers will be allocated strictly on the following priority basis:

 

1) Last year's permanent series number holders

2) Date of receipt

3) No known regular user of that number - suggest numbers over 100 for all entrants

 

Please supply a good action photograph (returnable).  Any size BUT  6" x 4" ideal.