Test Page

Polo #1 Size

Add Second Polo

Yes
No

Polo #2 Size

Add Third Polo

Yes
No

Polo #3 Size

Add Fourth Polo

Yes
No

Polo #4 Size

Add Fifth Polo

Yes
No

Polo #5 Size

First Name
Surname
Address
Suburb/Town
State
Postcode
Competitor Mobile #
Email
Car Club	Please enter the name of your Car Club IN FULL (eg. "South Eastern Automobile Club", NOT "SEAC").
Car Club Member #
Car Club Expiry
Proof of Car Club Membership	Upload a JPEG, PNG or PDF file here.
MA Licence #
MA Licence Expiry
Proof of MA Licence	Upload a JPEG, PNG or PDF file here.

Is the Driver the same as the Competitor/Entrant?	Yes No
First Name
Surname
Address
Suburb/Town
State
Postcode
Mobile #
Email
Car Club	Please enter the name of your Car Club IN FULL (eg. "South Eastern Automobile Club", NOT "SEAC").
Car Club Membership #
Car Club Expiry
Proof of Car Club Membership	Upload a JPEG, PNG or PDF file here.
MA Licence #
MA Licence Expiry
Proof of MA Licence	Upload a JPEG, PNG or PDF file here.
Emergency Contact Name
Emergency Contact Mobile #
Junior Competitor	Yes No
Is this your first time driving at Legend of the Lakes Hillclimb?	Yes No
Supplementary Regulations	I have read and understand the Supplementary Regulations.

Car Class - Friday
Car Class - Saturday and Sunday
Year of Manufacture
Make
Model
Registration #	If applicable.
Colour
Base CCs	Please enter a 4-digit number.
Turbo	Yes No
Supercharge	Yes No
Does the Vehicle have a Log Book?	Yes No
MA Log Book #
Proof of MA Log Book	Upload a JPEG, PNG or PDF file here.

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's Full Name
Driver's Age
Driver's Hometown
Driver's Occupation
Is the Driver a Rookie?	Yes No
How many years has the Driver been competing?
Prior National Competitions	Please list all National Competitions entered, including the year of Competition.
Prior State Competitions	Please list all State Competitions entered, including the year of Competition.
Sponsors
Additional Information	Any additional information to assist with promotion of the Driver.

2020 LEGEND OF THE LAKES HILLCLIMB

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.

Friday, 30th October	Yes No
Saturday, 31st October AND Sunday, 1st November	Yes No

Early Bird Entries close at 8.00pm on Thursday, 3rd September 2020.
Entries close at 8.00pm on Thursday, 10th September 2020.
Entry Fees	Please select your Entry Fee, as applicable.
Total Cost for Entry Fees	Please enter the total $ amount due for Entry Fees IN WHOLE NUMBER FORMAT (eg. "160", NOT "$160" or "$160.00". Use of $ sign and/or decimal points will result in error messages.
Do you wish to purchase additional Crew Passes?	Your Entry Fee includes Passes for 1 Driver and 2 Service Crew for each nominated day. 2 additional Crew Passes per Driver can be purchased for $10.00 each at the time of entry application. Due to COVID-19 Regulations, Crew Passes will NOT be available to purchase at the Event. Yes No
How many addional Crew Passes do you require?	@ $10.00 each.
Total Cost for Crew Passes	Please enter the total $ amount due for additional Crew Passes IN WHOLE NUMBER FORMAT (eg. "10", NOT "$10" or "$10.00". Use of $ sign and/or decimal points will result in error messages.
Total $ Amount Due	Please enter the total $ amount due for Entry Fees + additional Crew Passes (if applicable). Please use WHOLE NUMBER FORMAT (eg. "170", NOT "$170" or "$170.00". Use of $ sign and/or decimal points will result in error messages.
Payment Method	Only EFT Payment will be accepted. Please email remittance to info@seacsa.com.

In the unfortunate event that the 2020 Legend of the Lakes Hillclimb is cancelled due to COVID-19 circumstances, providing your bank account details here will assist us to refund your entry fees quickly.
BSB	A BSB (Bank-State-Branch) is a six-digit number that identifies banks and branches across Australia.
Account #
Account Name	Account Name refers to the account holder’s name, for example if your account was opened in your name and your name was John Smith, your account name would be John Smith.

Due to COVID-19 Regulations, Names and Contact Details of ALL Crew Members must be included at the time of entry application.
Number of Crew Members