2017 Rally Australia – Helicopter Registration Form (cont.)

The Event Administration

PO Box 1234

Coffs Harbour NSW 2450

Must be submitted by 1500, 16/11/2017

2017 Rally Australia
Helicopter Registration Form
1. Owner / Operators Details
Name / Company Name
Address
Billing Address
Phone Numbers: / Business / Mobile
Email Address
Insurance Details
CASA Operators Cert. Details.
2. Helicopter
Make & Model
Vehicle Colour
Passenger Number
Helicopter Registration
3. Operation
What will be the purpose during the rally?
Overnight Parking Location?
4. Helicopter Pilot
Name
Address
Email
Phone Numbers: / Business / Mobile
CASA Aviation Reference Number.
5. Flying Under Contract For
Name
Address
Email Address
Phone Numbers: / Business / Mobile
6. Registration
Fee – / $250.00
Payment of the registration fee can be made by:
- Cheque, Bank Draft, Telegraphic Transfer (all charges incurred will be charged to the sender) or
- Credit Card: Visa/Amex/Diners/MasterCard (a 1.5% surcharge will apply to all credit card transactions)
Electronic Funds Transfer / Payment by EFT (preferred method)
·  I have made an Electronic Funds Transfer for the total amount payable above:
·  Account: Rally Australia Pty Ltd
·  BSB: 083-166
·  Acct No: 82-646-0134
·  Reference: please use Owners Name as the reference
Credit Card / I authorise payment for the amount plus a transaction fee of 1.5%.
·  Card No:
·  Expiry Date: CCV No:
·  Cardholder Name:
7. Signature:
The pilot/s of the above helicopter agrees to attend the pre-briefing at 1830hrs Thursday 16 November 2017 at Rally Headquarters, Opal Cove Resort, Opal Blvd, Korora NSW 2450 and to comply with the rules explained at this briefing.
Signature / Date

Copies of documents that must be supplied with this form-

o  Operators Certificate

o  Insurance Certificate of Currency and Insurance Details

Note: Drones / Remotely Piloted Aircraft / Unmanned Aerial Vehicles (UAV’s) are not permitted at Rally Australia, with the exception of DJI Europe, the WRC Drone Partner.

Completed forms can be returned by email to

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