Bunbury Western Australia
Easter 9th - 13th April
KOOMBANA BAY RESORT
ENTRANT No. : .............................................
NAME .................................................................... PARTNER ....................................................................
Name of driver ....................................................................
CHILDREN .................................................................... (........) .................................................................... (........)
.................................................................... (........) .................................................................... (........)
please put childs age in the brackets as of April 1st 1998
PASSENGERS .................................................................... ....................................................................
ENTRANTS FULL ADDRESS .................................................................... ....................................................................
.................................................................... POSTCODE ....................................................................
TELEPHONE (home) .................................................................... (work) ....................................................................
CAR .................................................................... REGO No ....................................................................
MAKE / MODEL .................................................................... YEAR ............ BODY STYLE ...........................................
COLOUR .................................................................... ENGINE ....................................................................
CLUB NAME (if applicable) .................................................................... ASRF Membership No ...................................
T-Shirt size ........(S) ........(M) ........(L) ........(XL) ........(XXL)
please tick size applicable
ENTRY FEES
FAMILY .....$80.00 2 Adults & 2 Children under15 (1 x T-Shirt & goodie bag)
EXTRA CHILDREN .....$10.00 each (5-15 yrs)
COUPLES .....$60.00 (1 x T-Shirt & goodie bag)
SINGLE ENTRANT ....$45 (1 x T-Shirt & goodie bag)
BUDDY PASS ......$25.00 (entry to event only)
EXTRA T-Shirts ......$15.00 each Number required (........) sizes (........)
ACCOMODATION
(........) 3 BEDROOM CHALET ..................$100.00 Deposit*
(........) SELF CONTAINED CABIN ............$40.00 Deposit
(........) ENSUITE CARAVAN SITE ............$20.00 Deposit
(........) TENT SITE ....................................$40.00 Deposit
(........) POWERED CARAVAN SITE .........$20.00 Deposit
(........) 1only 10 bed Dormitory ...............$20.00 Deposit
Please include your accomodation Deposit with your ENTRY FEE when sending your CHEQUE!
Please include in your cheque any extra T-Shirt money.
Please indicate if you are sharing Chalet accomodation, and with whom.
Please indicate your 2nd choice for accomodation in the event your 1st choice is unavailale.
'Accomodation required from' Arrival date .......... Departure date ............ inclusive.
DISCLAIMER
I hereby agree to abide by all instructions of the Organisers of the 1998 SOUTH WEST SANDGROPER NATIONALS, and not to hold the West Australian Division of the Australian Street Rod Federation or any organiser of the 1998 SOUTH WEST SANDGROPER NATIONALS in any way responsible for any loss, damage or claim whatsoever arising out of any incident which I, or my vehicle may be involved in during the course of this event.
.........................................................................................Entrant Signature ...............................Date
Send entries to :
Dean Hollwarth
9 Amanda Drive
Kelmscott WA 6111
