PAYNTER DIXON NSW HISTORIC TOURING CARS NSW Historic Touring Cars CompetitorCompetitor name (if different from driver)Driver DetailsFirst Name*Last Name*Mobile No.*Email* Address* Street Address Address Line 2 City State Post Code Emergency Contact Name*Emergency Contact Number*AASA or CAMS License No.*License Expiry* Date Format: DD slash MM slash YYYY Racecar DetailsYear of Racecar*Please Select201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Make*Model*Colour*1st & 2nd Preferred Race Number*Capacity*Dorian NumberLog Book Number*Pit Crew*Please provide your pit crew names Friday PracticeFriday practice is included in your entry fee should you wish to participate.Would you like to participate in Friday practice?*YesNoGarage HireWould you like to hire a garage?*YesNoPayment / Terms & Conditions"I/We have read and understood the Supplementary Regulations issued for this Meeting and agree to be bound by them and by the National Competition Rules of the Australian Auto-Sport Alliance Pty. Ltd. (AASA) I/We also acknowledge and agree that neither Australian Auto-Sport Alliance Pty. Ltd., nor Benalla Auto Club Pty. Ltd., nor the sponsor organisations, nor the land owners or lessees, nor the organisers of the race meeting/ event, nor their respective servants, officials, representatives or agents (all of whom shall collectively be called "the Organisers"), shall be under any liability for my death, or any bodily injury, loss or damage which may be sustained or incurred by me, as a result of participation in or being present at the event, except in regard to any rights I may have arising under the Trade Practices Act 1974. I/We acknowledge that motor sport is dangerous and accidents causing death, bodily injury, disability and property damage can, and do, happen. I/We accept the conditions of, and acknowledge the risks arising from, attending or participating in the event and being provided with the event services by AASA and the Associated Entities.Acceptance of Terms & Conditions* I accept I/We have read the above terms and conditions. Entry Fee NSW Historic Touring Cars* Price: $ 650.00 Garage Hire - Practice - NSW Historic Touring Cars* Price: $ 175.00 Garage Hire - No Practice - NSW Historic Touring Cars* Price: $ 100.00 Online Booking Fee* Price: $ 5.00 NSW Historic Touring Cars $ 0.00 Credit Card* MasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Security Code Cardholder Name
