GEELONG VICTORIA AUSTRALIA
Surname.................................................................... Given Names.................................................... Under 25 [YES] [NO]
Address ...............................................................................................................................................................................
State ......................................................................... Postcode ............................. Phone No ............................................
ASRF Membership No ................................ Club (if any) ....................................................................................................
Number of dependant children ............................................................ Ages ......................................................................
(16's and over entering with family become buddy pass)
Entrants Car : Make .........................................................Year ....................................... Model .....................................
ASRF Classification (if in doubt contact your state stewards) ............................................................................................
T-Shirts one free with entry (circle size required)
Adult sizes ___________S ___________M ___________L ___________XL ___________XXL ___________XXXL
ENTRY FEE :
ASRF Members : Family : ....$95................................................... $___________
ASRF Members : Singles : ....$60.................................................. $___________
Non Federation Members : ...Add $40 to above scale....................$___________
Buddy Pass :............. $20 each (doesn't include entrants pack).......$___________
Extra T-Shirts : (circle size(s) required) $15 each............................$___________
Children.....8....10...12.....Adults....S....M....L......XL.XXL.XXXL
Quanities [__] [__] [__] .............. [__] [__] [__] [__] [__] [__]
................................................................................................TOTAL $___________
Entrants pack and TShirt not available to entries after 31st January 1999
ACCOMODATION DETAILS :
Camping available - 200 sites at complex ...........POWER [__] / NON POWER [__]
More details to follow, next advice
Please send completed entry form and cheque / money order to :
ASRF 14th Street Rod Nationals
PO Box 293
Chadstone VIC 3148
Contact : Brian Kenyon for more information (3) 5971 1079
Declaration : I, the undersigned hereby agree to abide by all the instructions of the organisers of the 14th Australian Street Rod Nationals and further agree not to hold the organisers in any way responsible for any loss, damage or claim what so ever, arising out of any incident which I, or my vehicle may be involved in during the course of this event. I have drawn these conditions to the attention of my family and Buddy/Buddies included on this form
Signed : .............................................................................................................. Date : ...................................................
Office Use
____________Date Received ___Amount_____________Extra Shirt_________________Entrant Number__________
