Silver Fern Rally Registration

Step 1 of 9

11%

Driver 1
Last Name*
First Name*
Street*
Town / City*
Region / State
Country*
Email address*
Phone*
Mobile phone*
Sex*
Age group*
Emergency Contact Name*
Emergency Contact Phone*

Save and Continue Later

Driver Details
Competition licence number*
Licence Grade*
Expiry date*
Financial member of...*
Club membership expiry*
Drivers licence number*
Drivers licence expiry*

Save and Continue Later

Driver 2 (co driver)
Last Name*
First Name*
Street*
Town / City*
Region / State
Country*
Email address*
Phone*
Mobile phone*
Sex*
Age group*
Emergency Contact Name*
Emergency Contact Phone*

Save and Continue Later

Co Driver Details
Competition licence number*
Licence Grade*
Expiry date*
Financial member of...*
Club membership expiry*
Drivers licence number*
Drivers licence expiry*

Save and Continue Later

Team/Service Manager Details
Last Name*
First Name*
Email address*
Phone*

Save and Continue Later

Address for Communications
(Identify person responsible for receiving Event Communications)
Contact Name*
Postal Address for event Communications*
Email Address*
Fax

Save and Continue Later

Vehicle Details
Vehicle Make*
Vehicle Model*
Year of Manufacture*
Engine Capacity (cc's)*
Event
Class*

Save and Continue Later

Terms and Conditions
I have read and understand the Terms and Conditions*
- I understand
I have read and understand the Terms and Conditions HERE

Save and Continue Later

Payment
Early Bird Silverfern 2018 Entry
Price: $ 11,000.00
Total
$ 0.00
Payment method*
If you would like to pay by credit card, we will call you for your credit card details.
I have made payment*
- I have made payment to the following account;
Bank Name
02-0404-0255632-00
$11,000.00 including GST
I would like more information on...
- Shipping and car transportation
- New Zealand customs requirements
- Vehicle rental services
- Accommodation

Save and Continue Later