Race Entry Form
Round 1 | Wyndham Harbour, VIC | February 25 & 26, 2024
Class
*
Please Select
65mph
85mph
Supercat Outboard
Supercat Extreme
Name of Boat
*
Race No. on Boat
*
State Boating Authority Registration No.
*
State Boating Authority Registration Expiry Date
*
Name of Owner
*
First Name
Last Name
Email
*
example@example.com
Owner's Club
*
Address of Owner
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
APBA Licence No.
*
For Non Champ Entry, Day License is required
Day Licence Form
Contact Number
*
Please enter a valid phone number.
Class of Boat
*
Capacity of Motor
*
Boat Length (Metres)
*
Boat Beam (Metres)
*
Driver 1
Name of Driver
*
First Name
Last Name
Driver's Club
*
State Boating Authority Licence No.
*
State Boating Authority Licence Expiry Date
*
APBA Licence No.
*
Contact Number
*
Please enter a valid phone number.
Email
*
example@example.com .
Driver 2
Name of Driver
*
First Name
Last Name
Driver's Club
*
State Boating Authority Licence No.
*
State Boating Authority Licence Expiry Date
*
APBA Licence No.
*
Contact Number
*
Please enter a valid phone number.
Email
*
example@example.com
Declaration by Owner(s): I/We, being the owner(s) of the abovementioned boat do hereby certify that the specifications of the boat's hull and motor are known to me/us to be in conformity with the Rules and Restrictions governing the class of the event entered. I/We will comply with the APBA RACING and SAFETY RULES in their entirety. I/We declare that the above particulars are to my/our knowledge true and correct.-----Signature of Owner(s)-----:
*
Declaration by Parent/Guardian:I/We, the undersigned, understand that the race entered is dangerous and acknowledge and accept entirely at my/our own rish, injury or damage to person or property which may be sustained or incurred as a result of or arising out of my child's participation in the said race or event. I/We further declare that if applicatble, I/We use at my/our own rish, a Reinforced Cockpit, Deflection Bar(s) or Restraining Belt(s), etc.---Signature of Parent or Guardian---:
*
Emergency Contact Name
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
RACE CLASS (All fees include GST)
*
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( X )
SUPERCAT EXTREME
(Per round of championship)
$
3,300.00
AUD
SUPERCAT OUTBOARD
(Per round of championship)
$
1,650.00
AUD
SPORTS 85 & 65
(Per round of championship)
$
825.00
AUD
SPORTS 85 & 65
(Non-champ Entry)
$
Free
AUD
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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