Grade Racing in
*
Please Select
A Grade 38ks
B Grade 38ks
C Grade 38ks
D Grade 38ks
E Grade 38ks
No Drop 26ks
Development 12ks
First and Last Name
*
Both first & last Names .... or we allocate points...
This week Race Date
*
-
Day
-
Month
Year
Date
Your Mobile number
*
-
Area Code
Phone Number
Your email
*
example@example.com
Emergency Contact Phone Number
*
-
Area Code
Phone Number
I am/have
*
A First-aider/first responder professional
A current first ad certificate
NOT competent as a first-aider
I want to Pay by:
Cash on Sunday
Online Now
By Automatic Payment
Sponsor
If you are a
Senior
| pay only $20 online or on the day
If you are a
Junior [under 17]
| pay only $15 online or on the day
Set up an AP 12-3147-0354579-00 | Reference » SURNAME | Code » WW
My Products
prev
next
( X )
Senior
Senior
$
20.00
NZD
Quantity
1
Junior
Senior
$
15.00
NZD
Quantity
1
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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Should be Empty: