Vintage Clubby Nomination Form

Vintage Clubby Nomination Form

Please see our website for information on classes (www.chargersrc.net)
Race Date*

DayMonthYear
Membership Category*

MemberMember (Family)Junior Member (16 & under)Non-MemberJunior Non-Member (16 & under)Prospective (First Time Race)
Driver Name*

First NameLast Name
Email*
Classes (Limit of 4)

Run for Fun - 2WDRun for Fun - 4WDCompetition Racer - 2WDCompetition Racer - 4WDVintage Trucker (pre 1999)Dirt Truck (99-2007)Retro VintageOG Buggy (no re-re's)
No of Classes
Adjusted Classes
2WD Class
4WD Class
How many junior entries?
Junior 1 Name
Junior 1 Class
Junior 2 Name
Junior 2 Class
Junior 3 Name
Junior 3 Class
Message to us
Include transponder details if new or updated
Dinner Required?*

YesNo
Fee Rate 1
Fee Rate 2
Fee Rate Jnr
Discount Rate
RACE FEE $
How to Pay*

PayPal (10% Member Disc)Direct DepositPay at Track
Fee + Discount + Surcharge
Direct Deposit Details

BSB: 014-274

Account: 30-687-1239

Name: Chargers RC
TOTAL RACE FEE

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AUD1.9% transaction fee applies with PayPal (applied after any discounts)