2017 Rally Australia Car No.

ASN VEHICLE ENTRY FORM

For competitors with non-homologated cars entering the WRC

1. Entry Details
Competitor Name:
(Must hold a CAMS licence)
CAMS Licence No: / ABN No (if applicable)
Phone: / Mobile:
Address:
Suburb: / State: / Postcode:
Email: / Fax:
Driver Name:
Civil Licence No: / CAMS Licence No:
Address:
Suburb: / State: / Postcode:
Phone: / Mobile:
Email: / Fax:
Next of Kin on event: / Name: / Mobile:
Co-Driver Name:
Civil Licence No: / CAMS Licence No:
Address:
Suburb: / State: / Postcode:
Phone: / Mobile:
Email: / Fax:
Next of Kin on event: / Name: / Mobile:
All event correspondence to: / Co Driver / Other / Details:
Sponsor (one only)
If required to appear on ARC entry list in lieu of Competitor / Name:
Team Manager: / Mobile:
Service Crew Chief: / Mobile:

2017Rally Australia WRC – ASN Cars

2. Disclaimer
Competitor / Entrant:
Driver: / Co-Driver:
For Competitors (formerly Entrants)
I/We being the competitor/s of the vehicle described on this Entry Form wish to enter that vehicle for the above event.
For Competitors (formerly Entrants) and competing crew
I/We being the Competitor (entrant)/s and/or driver and/or co-driver and/or navigator, certify that the particulars on this form are true and correct in every particular, to the best of my/our knowledge and belief.
I/We declare that I/we have read and understood the Supplementary Regulations issued for the event, and agree to be
bound by them and the provisions of the National Competition Rules of the Confederation of Australian Motor Sport Limited
(“CAMS”). In exchange for being able to attend or participate in the event (including entering the event), I agree:
  • to release CAMS and Australian Motor Sport Commission Ltd, promoters, sponsor organisations, land owners and
lessees, organisers of the event, their respective servants, officials, representatives and agents (collectively, the
"Associated Entities") from all liability for my death, personal injury (including burns), psychological trauma, loss
or damage (including property damage) ("harm") howsoever arising from my participation in or attendance at the
event, except to the extent provided by law;
  • that CAMS and the Associated Entities do not make any warranty, implied or express, that the event services will
be provided with due care and skill or that any materials provided in connection with the services will be fit for the
purpose for which they are supplied; and
  • to attend or participate in the event at my own risk
I/we acknowledge that:
  • the risks associated with attending or participating in the event include the risk that I may suffer harm as a result of:
  • motor vehicles (or parts of them) colliding with other motor vehicles, persons or property;
  • acts of violence and other harmful acts (whether intentional or inadvertent) committed by persons attending
or participating in the event; andthe failure or unsuitability of facilities (including grand-stands, fences and guard rails) to ensure the safety of persons or property at the event.
  • motor sport is dangerous and that accidents causing harm can and do happen and may happen to me.
  • the route instructions should not be relied upon exclusively in estimating the degree of severity of any hazard whichmight be encountered, or the manner in which any section of the road is driven, whether shown in the routeinstructions or not, and that I/We have been advised to exercise caution in following these route instructions.
I accept the conditions of, and acknowledge the risks arising from, attending or participating in the event and beingprovided with the event services by CAMS and the Associated Entities.
I/we acknowledge that my/our personal information will be processed in accordance with the CAMS privacy policy which is
available from and where I/we suffer from any injury, sickness or death during the Event, I/we consent to the release by health services of my/our personal health information to an authorised representative of the CAMS or the Event who may use it in the preparation and release within and outside of Australia of accident or incident information and reports to interested parties for the purposes of accident investigation, accident prevention and safety activities, news services including broadcast services, or for the purposes of processing insurance claims.
I understand that this disclaimer is not intended to exclude any valid claim I may have under the CAMS Personal Insurance
Scheme.
Competitors (entrants) Signature: / Date:
Driver’s Signature: / Date:
Co-Driver’s Signature: / Date:
For persons under the age of 18 years the parent/guardian consent must be completed (see page 3)

2017Rally Australia WRC – ASN Cars

3. Description Of Vehicle
Competitor / Entrant:
Driver: / Co-Driver:
Make: / Model:
Registration No: / Year:
Homologation No: / Log Book No:
Chassis No: / Engine No:
Base Colour:
Sign Writing & Colour:
ARCCLASS (check as appropriate) / Category (check as appropriate)
P1 – Up to 1400cc / N1 – Up to 1400cc / ARC Championship
P2 – 1401 – 1600cc / N2 – 1401 – 1600cc / 2WD Rally Championship
P3 – 1601 – 2000cc / N3 – 1601 – 2000cc / Kennards Cup
P4 – Over 2000cc 2WD / N4 – Over 2000cc
P5 – Over 2000cc 4WD / G2
P6 – Over 2000cc 4WD / S2000
G4 / AP4 Maxi Car / Using Pump Fuel
All vehicle details must be completed prior to submitting the entry form
4. Disclaimer (For persons under 18)
For persons under the age of 18 years the following parent/guardian consent must be completed
I [Name: ] of [Address ] am the parent / guardianof [Name ] who is under 18 years old. I have read this document and understand its contents, including the exclusion of liability and assumption of risk, and have explained the contents to the minor. I consent to the minor attending/ participating inthe event at his/her own risk.
Signature: / Date:

Save this form on your computer first and then fill in the form, use Tab key to move around. If paying by electronic funds transfer email the form as an attachment. If paying by cheque, print out the form and post with the cheque.

Rally Australia Pty Ltd
ABN 41 130 862 798
Tax Invoice
1. Entry Details
Competitor / Entrant:
Driver:
Co Driver:
2. Options Available
Item Description / No Required / Each (inc GST) / Total (inc GST)
Entry Fee / $2500.00 / $0.00
Service Vehicle Registration (2 free) / $130.00 / $0.00
Testing (4 hour session, max of 2 sessions) / $500.00 / $0.00
Removal of Organisers Advertising (Area G) / $660.00 / $0.00
Extra Road Book(s) and Map(s) / $55.00 / $0.00
GRAND TOTAL (inc GST) / $0.00
WRC Supp Regs Art 4.4.2 Non WRC Registered and Privateer Competitors
With optional advertising AUD$2,500 (including 10% GST)
Without optional advertising AUD$3,500 (including 10% GST)
Australian crews entered in the Australian Rally Championship (ARC) receive a $1,000 rebate on their entry fee.
This rebate will be paid subject to the crew starting the WRC event.
3. Payment (please tick one box)
Cheque: / Payment by Chequeto Rally Australia Pty Ltd for the total amount payable above.
Credit Card: / I authorise Credit Card payment for the amount plus a transaction fee of1.5%.
  • Card No:
  • Expiry Date: CCV No:
  • Cardholder Name:

Electronic Funds Transfer : / Payment by EFT (preferred method)
  • I have made an Electronic Funds Transfer for the total amount payable above:
  • Account: Rally Australia Pty Ltd
  • BSB: 083-166
  • Acct No:82-646-0134
  • Reference: please use Driver’s Surname as the reference

This document will constitute a Tax Invoice for GST when fully completed and payment is made.

Completed forms can be returned by email to