2012 mt baw baw sprint
TRANSCRIPT
2012 Mt BAW BAW SPRINT
EXPRESSION OF INTEREST FORMCOMPETITION - TOUR -
DRIVER Name:
Address:
Town/Suburb: _ Postcode:
Phone: (M) (W) (Fax)
Email:
CO-DRIVER Name:
Address:
Town/Suburb: _ Postcode:
Phone: (M) (W) (Fax)
Email:
VEHICLE Make: Model:
(TBA acceptable) Year: Engine Capacity: Reg No: Colour:
Forced Induction: Yes/No Four Wheel Drive: Yes/No Modified: Yes/No
Preferred Car Number: or or--------------------------------------------------------------------------------------------------------------------------
2012 Mt BAW BAW SPRINT (FEB 11 - 12) –$1,800.00*Tour Section - $600.00*
*Includes AASA Permit Fee
* From 1st January, 2010 a 3% surcharge will apply on all Credit Card payments
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Deposit Details- $500.00
I / We enclose cheque for $ (Payable to MOUNTAIN MOTORSPORTS P/L)OR
Please charge my credit card $ _ (M/C) (VISA) (B/C)
CREDIT CARD NO: EXPIRY:
CARD HOLDERS NAME:
SIGNATURE:
Please return completed form and $500 deposit to:
Mountain MotorsportsPO BOX 34Kilsyth 3137
Fax: 03 9779 6098
Email: [email protected]