ALL HISTORIC RACING PHEASANT WOOD CIRCUIT 2021 11th 12th September 2021 (Private Practice 10th Sep) Official Car Entry Form
Promoted by Pheasant Wood Pty Ltd. This event shall be held under Pheasant Wood Circuit Regulations, these Supplementary Regulations and any Further Regulations and instructions to entrants that may be issued. The organisers reserve the right to enter cars in events deemed appropriate subject to not being in conflict with the National rules.
TAX INVOICE: ABN: 93 143 985 853 Entries open 1st July 2021 and close August 16th 2021. This will be a combined Car and Motorcycle meeting. There will be Races and Regularity Trials for Pre-1961 Sports and Racing cars. There will be Races for Period 1. 2 & 3 solos and sidecars and Ride Day events for similar solos.
ENTER ONLINE AT pheasantwood.com.au OR COMPLETE THIS FORM
Car Entry Form.
Competitor (Car owner)
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Competition Licence No:
Driver
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Competition Licence No:
Driver’s Address
Street Address
Street Address Line 2
City
State
Postcode
Phone Number
Please enter a valid phone number.
Mobile Number
Please enter a valid phone number.
Work Number
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
Email
example@example.com
Car Info
Make
Model
Passport/ Log Book number
Year of Car
Capacity cc
Colour
Racing Or Regularity?
Car Club:
Preferred Number
Please provide actual or estimated lap time of Pheasant Wood Circuit or other (please specify)
Please provide somehistory of yourself and your car for the circuit commentary
Fees
Entry Fee $200.00
Same Driver 2nd Car $200.00
Regularity Entry $200.00
Cross Entry $200.00
FRI Practice $150.00
Note:
Timing transponders are included in fee. $250.00 fee is payable should you not return transponder on Sunday 12thSeptember. Ride day events shall not be timed.
FOR CREDIT CARD PAYMENT (No American Express or Diners Club)
Make Payment to: PHEASANT WOOD CIRCUIT Pty Ltd ABN: 93 143 985 853
Card Type
Mastercard
Visa
Bankcard
Credit Card
Total Amount $
Expiry Date
-
Month
-
Day
Year
Date
Name on card
Signature
Date
-
Month
-
Day
Year
Date
FOR CHEQUE PAYMENT PLEASE COMPLETE. All payments to be made to: Pheasant Wood Circuit Pty Ltd
Bank
Cheque Drawer
Cheque No
Entry Cheque
Bank Transfer: Pheasant Wood Pty Ltd
Pleaseuse ”All Historic & surname” as reference.
BSB: 032 102 ACC: 108 676
MAIL COMPLETED ENTRY FORM TO:
Pheasant Wood Circuit Po Box 20 Marulan NSW 2579
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