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2021 Targa Entry
Events
Targa NZ
Silver Fern Rally
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Driver 1
Last Name
*
First Name
*
Street
*
Town / City
*
Region / State
Country
*
Email address
*
Phone
*
Mobile phone
*
Sex
*
Male
Female
Age group
*
Under 19
19-25
26-35
36-60
60+
Emergency Contact Name
*
Emergency Contact Phone
*
Driver Details
Competition licence number
*
Expiry date
*
Drivers licence number
*
Drivers licence expiry
*
Driver 2 (co driver)
Last Name
*
First Name
*
Street
*
Town / City
*
Region / State
Country
*
Email address
*
Phone
*
Mobile phone
*
Sex
*
Male
Female
Age group
*
Under 19
19-25
26-35
36-60
60+
Emergency Contact Name
*
Emergency Contact Phone
*
Co Driver Details
Competition licence number
*
Expiry date
*
Drivers licence number
*
Drivers licence expiry
*
Team/Service Manager Details
Last Name
*
First Name
*
Email address
*
Phone
*
Address for Communications
(Identify person responsible for receiving Event Communications)
Contact Name
*
Postal Address for event Communications
*
Email Address
*
Fax
Vehicle Details
Vehicle Make
*
Vehicle Model
*
Year of Manufacture
*
Engine Capacity (cc's)
*
Event
Not sure
Historic Trophy
Challenge Rally
Class
*
A
B
C
D
E
F
G
H
Not sure
Terms and Conditions
I have read and understand the Terms and Conditions
*
I understand
I have read and understand the
Terms and Conditions HERE
Payment of non refundable deposit
2022 Silver Fern Rally Entry
Price:
Would you like Safety Notes? (extra $800 +GST)
*
Yes
No
Total
$ 0.00
Payment method
*
Bank transfer
Credit card
If you would like to pay by credit card, we will call you for your credit card details.
I have made payment of the non refundable deposit
*
I have made payment to the following account;
Bank Name
02-0404-0255632-00
$1,150.00 including GST
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2021 Targa Entry
Events
Targa NZ
Silver Fern Rally
FORMS
Livery Order Form
Gallery
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