Twin Peaks Port MacDonnell Hillclimb Entry Form

PLEASE NOTE: The appearance of this Entry Form may vary depending on the type of device you're using. For best results, please use either a Tablet or Computer rather than a Mobile Phone to view and complete your entry.

Before completing this form, please read the Supplementary Regulations and Disclaimer Form, which are available at http://www.seacsa.com/events/all-events/2020-02-08/twin-peaks-port-macdonnell-hillclimb/.

The Entry Form requires information regarding the Competitor/Entrant and the Driver, so please have all of this handy before you start.

You must complete all of the required fields (fields with a red star) before you will be able to submit your Entry.

The Entry Form and the Entry Fee must be received before your Entry is classed as complete. You will receive an automatic reply email with a notification that your Entry has been received, along with bank account details for Fee payment.

Your Entry will then be checked by organisers before it will be accepted. An official acceptance email will be sent once finalised – please be patient, this will take a little while.

= required

Email:

2020 TWIN PEAKS PORT MACDONNELL HILLCLIMB

Saturday, 8th & Sunday, 9th February 2020

CAMS Permit # - 520/0902/01

Please complete each field below IN FULL.
Please do not use "As Above" as a response, as doing so will result in incorrect data collection. If your entry includes "As Above" as a response, it WILL NOT BE ACCEPTED.

COMPETITOR/ENTRANT DETAILS

Competitor First Name
Competitor Surname
Competitor Address
Competitor Suburb/Town
Competitor State
Competitor Postcode
Competitor Mobile #
Competitor Email
Competitor Car Club
Competitor Car Club Member #
Competitor CAMS Licence #
Competitor CAMS Licence Expiry

DRIVER DETAILS

Is the Driver the same as the Competitor/Entrant?	Yes No
Driver First Name
Driver Surname
Driver Address
Driver Suburb/Town
Driver State
Driver Postcode
Driver Mobile #
Driver Email
Driver Car Club
Driver Car Club Member #
Driver CAMS Licence #
Driver CAMS Licence Expiry
Emergency Contact Name
Emergency Contact Mobile #
Junior Competitor	Yes No
Is this your first time driving at Twin Peaks Port MacDonnell Hillclimb?	Yes No
Please list your six most recent Competion experiences.
Supplementary Regulations	View Supplementary Regulations at http://www.seacsa.com/events/all-events/2020-02-08/twin-peaks-port-macdonnell-hillclimb/ I have read and understand the Supplementary Regulations.
Disclaimer Understanding	View Disclaimer at http://www.seacsa.com/events/all-events/2020-02-08/twin-peaks-port-macdonnell-hillclimb/ 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.

VEHICLE DETAILS

Class
Make
Year of Manufacture
Model
Registration #	If applicable.
Colour
Identification #
Base CC's	Please enter a 4-digit number.
Turbo	Yes No
Supercharge	Yes No
Does the Vehicle have a Log Book?	Yes No
CAMS Log Book #

SHARED VEHICLE DETAILS

Multiple entries for any car are permitted (to a maximum of two per vehicle). The entries must be on separate Entry Forms.
Entries may only be entered in one Class and one Category and must not be transferred without the Clerk of Course's permission.
Is this a shared vehicle?	Are you sharing this vehicle with another Driver? If so, the second driver MUST complete a SEPARATE Entry Form. Yes No
Driver 2 First Name
Driver 2 Surname
Driver 2 CAMS Licence #

FEES

Entry Fees	Please select your Entry Fee, as applicable.
Payment Method	If paying by EFT, please email remittance to info@seacsa.com. If paying by Cheque, please post to Twin Peaks Port MacDonnell Hilclimb, Event Secretary, PO Box 1551, Mount Gambier SA 5290.