4x4 Helicopter fundraiser Registration Form

East Coast 4X4 Helicopter Fundraiser Registration Form

Please book your Vehicle and team by filling the form below, specify and pay for the expected number joining your vehicle for the trip.
Driver Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*

Area CodePhone Number
Number of People in Your Vehicle*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current Affiliated Club
If not affiliated pay EC4WD club membership below
Vehicle Make and Model*
Vehicle Registration number*
Emergency Contact Person*
Emergency Contact Person's Phone Number*

Area CodePhone Number
DECLARATION
Please select and pay into ANZ 01-0641-0041777-00 .... Surname in REFERENCE and Reg into CODE*
prevnext( X )
4x4 trip with camping, dinner, breakfast and lunch (per person)
$670.00NZD Quantity
Item subtotal:$0.00NZD

EC4WD club registration for non NZ4WDA member
$65.00NZD

Total

$0.00NZD
Should be Empty:

East Coast 4X4 Helicopter Fundraiser Registration Form