2018 Entry Form Track Entry : Cobra Car Club of NSW

Cobra Car Club of NSW

25th Anniversary Cobra Nationals 2018

Track Competition Entry Form

 




* Your Given Name :

* Your Surname :




1st Drivers Details


All drivers will be required to sign-on at the track including signing the disclaimer form.
Download/Print Form. Failure to sign-on or to sign the disclaimer will exclude the driver from competing.


* Drivers Given Name :

* Drivers Surname :

* Gender :

* Over 60? :

Address :

Suburb/Town :

* State :

* Contact Phone(s) :

Mobile :

* Email :

Motel staying at :


Emergency Contact
Name :

Phone :


Competition Info
* Club Membership - Club :

No. :

Competition License - Type. :

No. :

* Select Track Package :
What is this?
Previous Wakefield lap time (for grouping). :

mm
:

ss
:

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Entrant T-Shirt
* Select Size :


Dinner(s) Attendance
Confirm Dinners Entrant will be Attending :
Friday Night
Saturday Night
Sunday Night
If this entrant has any special dietary requirements, please detail them here :




2nd Drivers Details

Click here for 2nd drivers details.



3rd Drivers Details

Click here for 3rd drivers details.



Vehicle Details



* Car Type (Cobra/Daytona/GT40 etc) :

Manufacturer :

Year of Manufacturer :

Colour (Body/Stripe) :


Classing Questions (please answer ALL questions)
* Is the car road regsitered :

Rego No. :

* First Date of Registration. :
Year :     Month :
(Registration Year & Month only requried if Vehicle Registration is set to YES above)
* What is the Engine Capacity? (cc/ci) :

* Aspiration :


Tyres
Brand/Type? :

* Are you running the Control Tyre? :

For the control tyre class, what is the UTQG treadwear rating of your tyres? :


Size : Width/Profile RIM Diameter (eg 255/60/R15)
Front :

Rear :

* What Class are you? (to be confirmed) :


Drivers will be required to sign-on at the track including signing the disclaimer form.

Failure to sign-on or to sign the disclaimer will exclude the driver from competing.



Extras



Additional T-Shirts @ $35 ea

Sizes :
S
(53.5cm)
M
(56cm)
L
(58.5cm)
XL
(61cm)
XXL
(63.5cm)
3XL
(66cm)
5XL
(71cm)
No. :
Enter Numbers Only









Additional Dinners @ $40 / person / night

Night :
Friday
Saturday
Sunday
No. :
Enter Numbers Only




If there are any special dietary requirements for additional dinner attendees, please detail them here :




(* Required Fields. ** Requried if 2nd or 3rd Driver is selected)