Khanacross Australian Title Online Entry Form

= required

Australian Title, Round 3 - SEAC

Date - 09th & 10th June 2018

CAMS Permit Number - 818/1006/02

Make & Model
Log Book Number (if applicable)

COMPETITOR/ENTRANT

Name
Address including suburb/town, state and postcode
Email Address
Phone Number
Club
Club Member Number
Cams Licence Number
Cams Licence Expiry Date

Driver 1

Class for Driver 1	STANDARD = production base vehicles on street tyres only : MODIFIED = rally car, race car and production based vehicles on rally tyres Class A (standard (street tyres only) cars up to 1300cc) Class A (modified (rally tyres) cars up to 1300cc) Class B (standard (street tyres only) cars from 1301cc to 1600cc) Class B (modified (rally tyres) cars form 1301cc to 1600cc) Class C (standard (street tyres only) cars from 1601cc to 2000cc) Class C (modified (rally tyres) cars from 1601cc to 2000cc) Class D (standard (street tyres only) cars from 2001cc to 3000cc) Class D (modified (rally tyres) cars from 2001cc to 3000cc) Class E (standard (street tyres only) cars over 3001cc) Class E (modified (rally tyres) cars over 3001cc) Class F (specials) Class G (standard (street tyres only) 4WD) Class G (modified (rally tyres) 4WD)
Is Driver 1 Entering a competition category?	No Yes - Ladies Yes - Junior
Name
Address including suburb/town, state and postcode
Email Address - if different to Competitor
Phone Number
Payment Method	Cash - at SEAC Office (Local Entries Only) Cheque - at SEAC Office (Local Entries Only) Online - Via EFT (please bring copy of your receipt to documentation)
Club
Club Member Number
Cams Licence Number
Cams Licence Expiry Date
Supplementary Regulations	I have read and understand the Supplementary Regulations
Disclaimer Understanding	I have read, understood, acknowledge and agree to the risk warning, disclaimer and indemnity document including the exclusion of statutory guarantees, warning, assumption of risk, release and indemnity. (This document is on the website with the supplementary regulations)

Driver 2

Add 2nd Driver	Yes No
2nd Driver Class	STANDARD = production base vehicles on street tyres only : MODIFIED = rally car, race car and production based vehicles on rally tyres Class A (standard (street tyres only) cars up to 1300cc) Class A (modified (rally tyres) cars up to 1300cc) Class B (standard (street tyres only) cars from 1301cc to 1600cc) Class B (modified (rally tyres) cars form 1301cc to 1600cc) Class C (standard (street tyres only) cars from 1601cc to 2000cc) Class C (modified (rally tyres) cars from 1601cc to 2000cc) Class D (standard (street tyres only) cars from 2001cc to 3000cc) Class D (modified (rally tyres) cars from 2001cc to 3000cc) Class E (standard (street tyres only) cars over 3001cc) Class E (modified (rally tyres) cars over 3001cc) Class F (specials) Class G (standard (street tyres only) 4WD) Class G (modified (rally tyres) 4WD)
Is 2nd Driver Entering a competition category?	No Yes - Ladies Yes - Junior
2nd Driver Name
2nd Driver Address including suburb/town, state and postcode
2nd Driver Email Address
2nd Driver Phone Number
2nd Driver Payment Method	Cash - at SEAC Office (Local Entries Only) Cheque - at SEAC Office (Local Entries Only) Online - Via EFT (please bring copy of your receipt to documentation)
2nd Driver Club
2nd Driver Club Member Number
2nd Driver Cams Licence Number
2nd Driver Cams Licence Expiry Date
2nd Driver Supplementary Regulations	I have read and understand the Supplementary Regulations
2nd Driver Disclaimer Understanding	I have read, understood, acknowledge and agree to the risk warning, disclaimer and indemnity document including the exclusion of statutory guarantees, warning, assumption of risk, release and indemnity. (This document is on the website with the supplementary regulations)

Driver 3

Add 3rd Driver	Yes No
3rd Driver Class	STANDARD = production base vehicles on street tyres only : MODIFIED = rally car, race car and production based vehicles on rally tyres Class A (standard (street tyres only) cars up to 1300cc) Class A (modified (rally tyres) cars up to 1300cc) Class B (standard (street tyres only) cars from 1301cc to 1600cc) Class B (modified (rally tyres) cars form 1301cc to 1600cc) Class C (standard (street tyres only) cars from 1601cc to 2000cc) Class C (modified (rally tyres) cars from 1601cc to 2000cc) Class D (standard (street tyres only) cars from 2001cc to 3000cc) Class D (modified (rally tyres) cars from 2001cc to 3000cc) Class E (standard (street tyres only) cars over 3001cc) Class E (modified (rally tyres) cars over 3001cc) Class F (specials) Class G (standard (street tyres only) 4WD) Class G (modified (rally tyres) 4WD)
Is 3rd Driver Entering a competition category	No Yes - Ladies Yes - Junior
3rd Driver Name
3rd Driver Address including suburb/town, state and postcode
3rd Driver Email Address
3rd Driver Phone Number
3rd Driver Payment Method	Cash - at SEAC Office (Local Entries Only) Cheque - at SEAC Office (Local Entries Only) Online - Via EFT (please bring copy of your receipt to documentation)
3rd Driver Club
3rd Driver Club Member Number
3rd Driver Cams Licence Number
3rd Driver Cams Licence Expiry Date
3rd Driver Supplementary Regulations	I have read and understand the Supplementary Regulations
3rd Driver Disclaimer Understanding	I have read, understood, acknowledge and agree to the risk warning, disclaimer and indemnity document including the exclusion of statutory guarantees, warning, assumption of risk, release and indemnity. (This document is on the website with the supplementary regulations)

Driver 4

Add 4th Driver	Yes No
4th Driver Class	STANDARD = production base vehicles on street tyres only : MODIFIED = rally car, race car and production based vehicles on rally tyres Class A (standard (street tyres only) cars up to 1300cc) Class A (modified (rally tyres) cars up to 1300cc) Class B (standard (street tyres only) cars from 1301cc to 1600cc) Class B (modified (rally tyres) cars form 1301cc to 1600cc) Class C (standard (street tyres only) cars from 1601cc to 2000cc) Class C (modified (rally tyres) cars from 1601cc to 2000cc) Class D (standard (street tyres only) cars from 2001cc to 3000cc) Class D (modified (rally tyres) cars from 2001cc to 3000cc) Class E (standard (street tyres only) cars over 3001cc) Class E (modified (rally tyres) cars over 3001cc) Class F (specials) Class G (standard (street tyres only) 4WD) Class G (modified (rally tyres) 4WD)
Is 4th Driver Entering competition category	No Yes - Ladies Yes - Junior
4th Driver Name
4th Driver Address including suburb/town, state and postcode
4th Driver Email Address
4th Driver Phone Number
4th Driver Payment Method	Cash - at SEAC Office (Local Entries Only) Cheque - at SEAC Office (Local Entries Only) Online - Via EFT (please bring copy of your receipt to documentation)
4th Driver Club
4th Driver Club Member Number
4th Driver Cams Licence Number
4th Driver Cams Licence Expiry Date
4th Driver Supplementary Regulations	I have read and understand the Supplementary Regulations
4th Driver Disclaimer Understanding	I have read, understood, acknowledge and agree to the risk warning, disclaimer and indemnity document including the exclusion of statutory guarantees, warning, assumption of risk, release and indemnity. (This document is on the website with the supplementary regulations)
Will you be attending the presentation BBQ? If yes please complete the extra details below	Yes No
How many adults will be attending the presentation BBQ?	1 2 3 4 5 6 7 8 9 10
How many children will be attending the presentation BBQ?	None 1 2 3 4 5 6 7 8 9 10
	SUBMIT ENTRY