Response-O-Matic Form

RALLY ENTRY FORM

Just complete this form. Click on Submit when ready to send.

Information given in this form will be used only for the purposes of this rally and will not be given to any other organisation. For your personal motorcycle security it is advisable to not give the exact garaging address of your motorcycle.

Your Name:

Postal Address: (to send badge to)

Postcode:

Your Email:

The following information is required to enter prize categories

LONGEST DISTANCE

Gender:	Male Female

What do you ride?
Address (to measure longest distance from)
Suburb:
City:
State:
Country:

Combined age of bike and rider is years.
(photo of bike and rider required!)

Best Rat Bike: email or post in photo and write a brief description of modifications.


Hard Luck Award:


Email scanned photos to: [email protected]
or include photos with your entry form and fee. Please print name and return address on back of photos to insure safe return.

I give permission for my photo/story to be published on this website.

Click to go to a printer friendly entry form.