Car Club Entry Form

Bathurst Light Car Club

Event Entry Form

Event Name Date Location

Entry Fee

Personal Information First Name:             Last Name:

Email:                     Phone Number:

Address:                 City:

State:                     Zip Code:

Vehicle Information

Make: Model: Year:

Engine Capacity: Cylinders: Wheelbase: Class:

Color: License Plate Number:

Motorsport Australia Licence Do you have a current Motorsport Australia Licence? Yes No

If yes, please select your licence category:

Car Club Entry Form

Payment Information

Credit Card Type:

Credit Card Number:

Expiration Date:

CVV Code:

Release of Liability

I acknowledge that I am responsible for the safe operation of my vehicle at all times and that I will comply with all traffic laws and regulations. I also release the car club and its members from any liability for any accidents or damages that may occur while participating in car club events.

Submit

By clicking "Submit", I confirm that I have read and agree to the car club's rules and regulations, and that the information I have provided is true and accurate to the best of my knowledge.