Hella High Country Entry Form 2012

"use this form below to electronically submit, for other methods just print out this form"

 

          November 10/ 11th, 2012 (Erica,Moondarra, Tanjil, Walhalla Vic)

 

Team name :          

Team postal address:

Team email address:  (Will email instead of post)

Optional 2nd Email address: 

Telephone number with contact name:   

Driver:

Navigator:

 

Total cost is:

$300 (inc.GST)per Team of 1 vehicle

(inc. 2 x adult meal tickets & camping fees)

 

Additional ONLY passengers for dinner & camping fees

Adults and over 12 $25 each

Under 12 $15 each

 

Over 12

 

Under 12

 

 

Payment Options

Total Cost $

*click here to view Condtitions of Entry and Refunds

Credit Card Number
Expiry Date  
Account Name

Post to: The Rabbit Trap Company P/L, 15 Nirvana Close, Langwarrin South Vic, 3911.

Or Fax your entry form to (03) 9776 6798 or Telephone 0428 534 102.

Or direct debit: Account Name: The Rabbit Trap Company P/L BSB: 033 362 Account Number: 113 505