RTDC Motorkhana Round 1 event registration

First Name *

Last Name *

Address *

Suburb *

State *

Postcode *

Phone *

Email *

Please select No if you do not want to receive future promotion, offers and communication from RTDC *

Next of Kin or Emergency Contact *

Phone Number *

Do you require a Motorsport Australia 1 day Come & Try licence? *

Motorsport Australia Licence number *

Licence Expiry date *

Car Club Membership *

Car Club Member Number *

Car Club Membership Expiry date *

Name of other driver *

Vehicle Model *

Vehicle Make *

Car Colour *

Class *

Is the car double entered? *

Yes, *

I have read the supplementary Regulations

Amount

$

By registering for this event, I accept the Disclaimer - Exclusion of Liability

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