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CLIFFHANGER ( 4/5th July, 2011 )

Competitors and Spectators: Please read the conditions before submitting your entry.

Competitor

Spectator

Competitor Team Name

Competitor Drivers Name

Competitor Navigators Name

Spectator/ Competitor address:

Email address: (Will email instead of post)

Optional 2nd Email address:

Telephone number with contact name:

Spectator Details
Spectator name:
Spectator name:
Spectator name:
Spectator name:
Spectator name:
		Select payment type I wish to pay by the month* Total Amount $
Credit Card Number	*note 1. 5% surcharge applies if paying by credit card
Expiry Date
Card Name

Post with a cheque or money order payable to Cliffhanger 4wd Events to 15 Nirvana Close, Langwarrin South Vic 3911.

Direct debit is also accepted. Account Name: Navrun BSB: 733138 ACCOUNT NO: 687165. WESTPAC.

Or fax your entry form on (03) 9776 6798 or telephone 0428 534 102

(Note: Credit cards are accepted, however a 1.5% surcharge will apply)