Entry Form
Date: 14th – 15th August 2010
2010 Collie Crown Weekend An alcohol think again Event
Promoter: The Vintage Sports Car Club of WA [ Inc.] 610/1508/01
Held under the International Sporting Code of FIA and the National Competition Rules of CAMS.
1st Driver
Name / / First time driver /
Postal Address / / Post Code /
Will you officiate? / Mt Clarence / / Sunday / / Monday /
CAMS Licence No / / Bus. Phone / / Home Phone /
E-mail / / Mobile /
2nd Driver
Name / / First time driver /
Postal Address / / Post Code /
Will you officiate? / Mt Clarence / / / Sunday / / Monday /
CAMS Licence No / / Bus. Phone / / Home Phone /
E-mail / / Mobile /
Competitor (owner of vehicle)
Name / / First time driver /
Postal Address / / Post Code /
CAMS Licence No / / Country Competitor /
Vehicle Details
Year, Make, Model /
Cubic Capacity (cc) / / Dorian # / / CAMS Log Book No. /
Colour / / Preferred Car No / / Class /
CAR VSCC LOG BOOKED / / Log Book No. /
Remittance - 2010 Collie Crown Weekend / Unit price / Number Req'd / TOTAL
Hillclimb Entry / $80.00 / /
Regularity Entry / $120.00 / /
2nd Driver Entry Regularity / $40.00 / /
Discount per driver for two events / - $20.00 / /
Driver training Entry / $10.00 / /
Temporary Club Membership only available once per year (if required) / $20.00 / /
Dorian Hire -- Regularity / $20.00 / /
Total Remittance / TOTAL /
Cheque or money order payable to the:
The Vintage Sports Car Club of WA Inc. / Do you require a Tax Invoice? / / Receipt? /
Post with remittance to: / VSCCWA Entries / Any queries? / Contact: Lynn Oxwell
PO Box 1097 / Telephone / 9401 1449
Hillarys WA 6923
E-mail /
Office Use Only
Date Received / Date Entry Accepted
Amount Received / Sec. of Meet. Signature
Receipt Number
Name on cheque
No
Closing Date 23rd July 2010