Australian Production Cars

Entry Form

Races (more than one option can be chosen) - Secure payment form at bottom of page. *

Name *

Address *

Suburb *

Post Code *

Email Address *

Mobile Number *

CAMS Licence Number *

CAMS Licence Expiry *

Affiliated Club *

Affiliated Club Expiry *

Make *

Model *

Year *

Colour *

Capacity *

Preferred Race Number *

Sponsor *

Driver 1 Name *

Address *

Suburb *

Post Code *

Email Address *

Mobile Number *

CAMS Licence Number *

CAMS Licence Expiry *

Affiliated Club *

Affiliated Club Expiry *

Driver 2 Name

Address

Suburb

Post Code

Email Address

Mobile Number

CAMS Licence Number

CAMS Licence Expiry

Affiliated Club

Affiliated Club Expiry

Signature *

Total *

$ 0.00

Card Payment (leave blank if paying via Bank Deposit - BSB 014245 Account 644432351)

Card

Name on Card