2020 High Country Challenge Order Number Your Name: * Your Email: * Your Contact Number: * Optional Second Email: Postal Address: (inc. postcode and state) Team Name: Driver's Name: Navigator's Name: Your Vehicle Details: (eg.Nissan Patrol GQ, 2” lift, 35” mud tyres. Front diff lock, Etc.) Extra Passenger Name/s (note if they are Under 16 please) Cost is $350 Includes all maps, notes, 1 x dinner and 2 x breakfasts Extra $30 for more passengers to cover catering. U16 are FREE A $50 deposit will be required to secure your entry, We will email you with further details. Total Amount (please insert) $50 deposit $350 full amount of entry Payment Options: Please Select Credit Card Direct Debit Will pay when asked by Navrun 4wd Events Credit Card Numbers: Name on Card: Expiry Date: Please type in this box any requests, comments or questions you may have. Telephone 0459 995 551 Peter Butcher Post to: Navrun 4wd Events, 15 Nirvana Close, Langwarrin South Vic, 3911. Or Fax your entry form to (03) 9776 6798 Or Direct Debit: Account Name: Navrun BSB: 033 362 Account Number: 113 505 *click here to view Conditions of Entry and Refunds
