CT Civil New Zealand National Finals

Entry Form

CT Civil New Zealand National Finals
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
2 digit day, 2 digit month, 4 digit yearDate
Club Driver Belongs Too
DOB (if driver under 18 years of age)

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Transponder Details Number
This is not your race number. If you don't have one and are hiring, put 123456
Next of Kin Details

First NameLast Name
Next of Kin Phone Number

Area CodePhone Number
Are you attending prizegiving?
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
Entry Fees

Select all that apply per entry. If you are entering more than one car you do a full form again so we can capture all details.
Entry Selections
prevnext( X )
Adult Entry Fee
$480.00 NZD

Kiwi Trucks/Kids

$75.00 NZD

Total

$0.00 NZD
Spark arrestors are mandatory – maximum of 3mm hole size for the spark arrestors. Competitors must ensure their vehicle complies with this requirement before arriving at the event.
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, and you have entered.
Date Completed

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Should be Empty:

Entry Form

Racer Information

Additional Details

Vehicle Details

Entry Fees

Entry Selections *

All payments are to be made to Canterbury Off Road Club

Entry Selections