2011 SHELBY FESTIVAL

Proudly presented by:

Lumley Special Vehicles

& COBRA CAR CLUB OF VICTORIA INC

26th March 2011 - WINTON RACEWAY Winton Victoria

27th March 2011 - MOTOKHANA – Wangarratta Saleyards Wangarratta

COMPETITORS DETAILS

Name (Competitor 1) / Competition Licence No: / M / F
Name (Competitor 2) / Competition Licence No: / M / F
Name (Competitor 3) / Competition Licence No: / M / F
Address
(competitor 1) / State / P/Code
Contact Phone No. / Home : / Mobile : / Email :

VEHICLE DETAILS Tick all boxes below that represent your vehicles details.

MAKE / MODEL
ENGINE SIZE / DETAILS
Quote engine size in cc.
REGISTRATION No.
Engine Class
Multi-cam engine under 5100cc / Multi-cam engine with a total displacement (including oversizes) <5100cc (about 311ci) [Ford Modular and Toyota V8s]
Forced induction / Engine utilizing any form of inlet manifold pressurisation
Engine Modifications
Non-Factory Heads
Tick the box if you have non-factory heads. / Non-Factory casting on the engine. (Windsor/Cleveland cross breads allowed – don’t tick).
Non-Standard Carburetor/Injection
Tick the box if your carby/injection does not meet this description. / Single carburetor with a max of 4 barrels, Fuel Injection with a single throttle body and a single butterfly and a maximum of 8 injectors. Single LPG gas converter and/or single LPG throttle body.
Cam Specification
Tick the box if your cam is greater than or equal to these specs. / Maximum lift and duration of the cam:
·  Duration at .050" 220/220,
·  Valve Lift is .500/.500
In any combination of lift and duration.
Computer aided systems (traction, stability, ABS)
Tick the box if you have any of these fitted. / Traction control, stability control, ABS, launch control.
Aero Modifications
Tick the box if you have any of these fitted. / Non-Standard windscreen, Rear Spoiler, undercar air diffuser, front spoiler / air dam or any external devices added to the vehicle that may affect downforce, handling or stability.
Daytona Cobra coupes are classed as Aero modified vehicles.
Wheels
>= 17inch wheels / Wheel diameter is greater than or equal to 17 inches
Tyres
Speed Rating > ‘H’ / Tick if the speed rating of your tyre is > ‘H’
Road / Track Tyres / Tick if you have Non DOT Tyres / performance imports.
Racer
No registration / race built / Any vehicle without club or State road registration or Vic road permit, including cars purpose built for the race track.


2011 SHELBY FESTIVAL

COSTS & PAYMENT DETAILS

Single Competitor (Includes all meals) $ 280.00 / $

Second Competitor (Includes all meals) $ 230.00

/ $

Third Competitor (Includes all meals) $175.00

/ $

Meals Total for NON COMPETITORS (refer below for costs)

/ $

Grand Total

/ $
Please forward your non refundable payment & entry form to: / Enquiries - Tony Cram (03)9841 0274
or mobile 0416 084 664
Cobra Car Club of Victoria
c/o 13 Cassowary Street
Doncaster East VIC 3109 or
Email : / Alternative Payment by Electronic Transfer to:
Commonwealth Bank
Cobra Car Club of Victoria Inc.
BSB : 063 549
A/C No. : 10356848
(Please email receipt number details after transfer completed)

ENTRIES CLOSE Monday 14th March 2011

Late entry fee on the day (no exceptions) will incur an administration fee of $30.00 / Competitor

MEALS REGISTER – Competitors and non- competitors

For non competitors please indicate how many meals you will be attending. Children Under 12yrs are free.

DATE / DESCRIPTION / Enter the Number of persons attending the meals.
Competitors/ non- competitors and kids
Friday
25th March 2011 / Meet and Greet
Time: 5:00pm Pizza 6:00pm onwards
Quality Hotel Wangarratta Gateway
29 – 37 Ryley Street
Wangarratta VIC 3677
No Charge
Saturday
26th March 2011 / Dinner and Presentations
Time: 7:00pm
To be announced
$40.00 per Non Competitor
Sunday
27th March 2011 / Sunday Afternoon Presentation - Spit Roast
At Merriwa Park after the Motokhana
$15.00 per Non Competitor
Total Cost for meals
(Non Competitors) / $
Please add this to the entry details section

ACCOMODATION: PLEASE CALL THE HOTEL TO BOOK YOUR ROOM

Please mention you are with the COBRA CAR CLUB OF VICTORIA to obtain a room and the special rate.

Quality Hotel Wangarratta Gateway

29 – 37 Ryley Street

Wangarratta VIC 3677

Phone: (03) 5721 8399

www.wangarattagateway.com.au


2011 SHELBY FESTIVAL

DISCLAIMER for WANGARATTA SALEYARDS

To be signed on the day of the Event

ENTRANTS DISCLAIMER/ DECLARATION

I/We of

being the entrant/s of the vehicle described on this entry form wish to enter that vehicle for the above mentioned meeting. I/We declare that the particulars on this form are true and correct in every particular, to the best of my/our knowledge and belief.

You are invited to seek legal advice before signing this document.

ENTRANTS AND DRIVER DISCLAIMER AND DECLARATION

I/We have read and understood the Supplementary Regulations issued for this meeting and agree to be bound by them and by the National Competition Rules of the Australian Auto-Sport Alliance Pty. Ltd. (AASA).

I/We know that motor sport is dangerous and that accidents causing death, bodily injury, disability and property damage, can, and do happen.

I/We also acknowledge and agree that neither Australian Auto-Sport Alliance Pty. Ltd.,nor the sponsor organisations, nor the land owners or lessees, nor the organisers of the event, nor their respective servants, officials, representatives or agents (all of whom shall be collectively called “the organisers”), shall be under any liability for my death, or any bodily injury, loss or damage which may be sustained or incurred by me, as a result of participation in or being present at the event, except in regard to any rights I may have arising under the Trade Practices Act 1974.

Entrant’s Signature: Date:

Driver’s Signature: Date:

Driver 2 / Co-driver Signature: Date:

Driver 3 / Co Driver Signature: Date

CONSENT FOR ENTRANTS AND COMPETITORS UNDER 18 YEARS

I being the parent/guardian of (please name),

have read the whole of this document and consent to him / her participating. In doing so, I acknowledge that Motor Sport is dangerous, and agree that neither Australian Auto-Sport Alliance Pty. Ltd. nor “the organisers” shall be under any liability whatsoever for any death or bodily injury, loss or damage which may be sustained or incurred by the above named minor, or by me, howsoever such death or bodily injury, loss or damage is caused by negligence or otherwise.

Signed: Date:
SIGNATURE OF PARENT / LEGAL GUARDIAN