• 500 Car Club Khanacross Entry Form

    Baskerville Raceway

  • Entry Details (Competitor/Entrant)

  • Is the Competitor/Entrant the Same as the Driver 1?*

  • Entry Details (Driver 1)

  • Is there a second Driver*

  • Entry Details (Driver 2)

  • Is Driver 2's Next of Kin the same as Driver 1*
  • Is there a third Driver*

  • Entry Details (Driver 3)

  • Is Driver 3's Next of Kin the same as Driver 1*
  • Is there a fourth Driver*

  • Entry Details (Driver 4)

  • Is Driver 4's Next of Kin the same as Driver 1*

  • Vehicle Details

  • Drive Type*
  • Capacity*

  • Entry Fee Payment Options

  • Payment via?*

  • PayPal (Including Credit Cards

    prevnext( X )
    AUD

  • If you wish to pay by Credit Card, please select "Pay with a Card" at the PayPal Login Screen as shown below, otherwise log into PayPal as normal.

  • SAMPLE PAYPAY LOG IN SCREEN

  • Payment Via EFT;

    Electronic Funds Transfer Details:
    Account Name: 500 Car Club of Tasmania
    BSB: 067 002 Account No: 2801 2996

    *please use Drivers surname as the reference

  • Form Submission

    Details of the person submitting the form
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  • Should be Empty: