2025 Mainland Challenge Entry Form

Entry Form

Mainland Challenge 2025
Racer Information

Please fill name and contact information
Drivers Name*

PrefixFirst NameLast Name
Address*

Street Address

Street Address Line 2

City

Postal / Zip Code
Email Address*
example@example.com
Phone Number

Area CodePhone Number
Competition Licence Number*
ORANZ Licence Expiry Date*

DayMonthYear
Date
Club Driver Belongs Too*
DOB (if driver under 18 years of age)

DayMonthYear
Date
Transponder Details*
If you don't have one and are hiring, put 123456
Yes
Next of Kin Details*

First NameLast Name
Next of Kin Phone Number*

Area CodePhone Number
YesNo
If you are attending, how many people.
Additional Details

(To be completed in all cases if the Owner of the vehicle is other than the driver)
Owners Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owners Phone Number

Area CodePhone Number
Vehicle Details
CC Capacity*
Car Number*
Vehicle Sponsors and online details if available (Website/Facebook page ETC ETC)
Please detail racing history for commentators and promotional material
Please Upload a Picture of Your Car We Can Use

Cancelof
Mainland Challenge 2025 Entry Fee

Select all that apply per entry. If you are entering more than one car you do a full form per car.
Entry Selections *
prevnext( X )
Short Course Saturday Only
$300.00NZD



Enduro Sunday Only
$300.00NZD



Early Bird Both Days
$480.00NZD



Kiw Trucks (Free)
Don't Pay anything for this entry.

$0.01NZD



Transponder Hire
If you checked to hire a transponder earlier in the form, you must tick this and pay with entry.

$50.00NZD



Total

$0.00NZD
All payments are to be made to Canterbury Off Road Club

03 1593 0018939 00 please use your surname and car # for reference. You are not confirmed entered until you have paid, and we see it in our account.
Date Completed

DayMonthYear
Date
Should be Empty:

Entry Form

Racer Information

Additional Details

Vehicle Details

Mainland Challenge 2025 Entry Fee

All payments are to be made to Canterbury Off Road Club