ENTRY FORM           Numurkah Rotary Club 10th  4WD Alpine Trip 2015
 
Friday  10th April till Sunday  12th April 2015               Fee $120 each adult
 
Participant Names                   ……………………………                         $…..
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                                                                   Total fees  Paid              _____
                                      By     Direct Credit/Cheque /  Money Order / Cash
Vehicle Make ………………………
Model   ………………………………
Registration Number……………………..
 
Rules and Regulations
  1. Entries will be accepted on first come basis with full fees payment.
  2. Direct Bank to 083-760Acc No 1673 44745
  3. Return toNumurkah Rotary 4WD Trip,
                            C/o PO Box 149,                                                 
                            Numurkah 3636
    4.  Cheques payable to Numurkah Rotary  4WD Account
    5.  Vehicles must be mechanically sound in Road Worthy Condition and have current Registration and your own Insurance.
    6.  Drivers must hold a current Drivers Licence.
    7.  Rules and Regulations are subject to change.
     
    I have read the rules and regulations and acknowledge and agree as a condition of participation that neither the Rotary Club of Numurkah Inc., or its Members or helpers shall be under any liability whatsoever for any loss, damage or bodily injury or death sustained or incurred by myself and participants listed above whether by negligence or otherwise. All the above entrants are aware of the conditions and undertake to comply with all requests and directions of the Organizers of this event.
     
    Signature of a representative of above participants…………………………………..
     
    Date………………….                                   Phone Number…………………..
     
    Contact details if not already provided or changed
    Address…………………………………………………… email (desirable for contact )