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Competitor
Competitor Team Name
Competitor Drivers Name
Competitor Navigators Name
Spectator/ Competitor address:
Email address: (Will email instead of post)
Telephone number with contact name:
Spectator Details
Spectator name: 5 Day Spectator $390 5 Day Spectator age 10-16 $170 Spectator Daily $90 Spectator Daily age 10-16 $40 Under 10 are FREE 5 Day spectator "no camping" $250 5 Day spectator "no camping" age 10-16 $100 Spectator Daily "no camping" $50 Spectator Daily "no camping" age 10-16 $20
I wish to pay by the month* Please Make Selection $100 per month $200 per month $300 per month $400 per month $500 per month
Total Amount $
Credit Card Number
Mastercard Visa
*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)