Spring 200 VCRS and Anglia Memorial Entry Form

Competitor (CAR Owner):
Competitors Name (required): Surname First Name
Competitors Date of Birth (required): //
Competitors Address:
Suburb: Postcode:
Mobile Phone (required): Work Phone
Email:
Competitors CAMS Licence Number (required) :
Competitors CAMS Licence Expiry Date (required): //

Atttributed Competitor / Sponsor:

Driver Details:
Drivers Name (required):Surname First Name
Drivers Date of Birth (required): //
Address:
Suburb: Postcode:
Mobile Phone (required): Work Phone
Email (required):
Drivers Grade (required):
Drivers Car Club (required):
Drivers Car Club Member Number (required):
Car Club Expiry Date (required): //
Drivers CAMS Licence Number (required) :
CAMS Licence Expiry Date (required): //
Drivers Civil Licence Number (required) :
Civil Licence Expiry Date (required): //
Event Driver Officiated at (required) :
Officialing Date (required): //
Drivers Emergency Contact (required):
Drivers Emergency Contact Phone Number (required):

Co-Driver Details:
Co Drivers Name (required):Surname First Name
Co-Drivers Date of Birth (required): //
Address:
Suburb: Postcode:
Mobile Phone (required): Work Phone
Email:
Co-Drivers Grade (required):
Co-Drivers Car Club (required):
Co-Drivers Car Club Member Number (required):
Car Club Expiry Date (required): //
Co-Drivers CAMS Licence Number (required) :
CAMS Licence Expiry Date (required): //
Co-Drivers Civil Licence Number:
Civil Licence Expiry Date: //
Event Co-Driver Officiated at (required):
Officialing Date (required): //
Co-Drivers Emergency Contact (required):
Co-Drivers Emergency Contact Phone Number (required):

Vehicle Details:
Vehicle Make: Model: Year:
Engine Capacity: Reg. Number:
Colour:
Engine Number: Logbook Number:
Turbo:

Class:

Drive Configuration:

Vehicle Type:

Scrutiny and Points
Scrutiny:

Our Crew wishes to gain VCRS Points:

Our Crew wishes to gain VCRS Senior Cup Points:

Driver wishes to gain Junior Cup Points:

Co-Driver wishes to gain Junior Cup Points:

Nominated Car Club:

Service Crew
Service Crew Contact (name):
Service Contact Number:

Event:
Please indicate which event you would be interested in entering:

Payment:
Payment may be made by Direct Deposit details listed in Clause 13.6 of the Supplementary Regulations or via Cheque/Money Order or Cash. Event fees are set out in Clauses 13.4.1 to 13.4.3
How will you be paying your entry fee(s):

Crews Understanding:

Signatures for the Competitor, Driver and Co-Driver and any Parent/Guardian Consent must be completed at Official Scrutiny or Event Documentation prior to the commencement of the event.

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