2013MOTIVE AIRPORT THRASH

JET MULTIMEDIA PTY LTD

PO BOX 7083 Silverwater NSW 2128

ABN: 26147106849

ENTRY FORM

DRIVER DETAILS

NAME:

ADDRESS:

MOBILE:

EMAIL:

LICENCE No:STATE:EXPIRY:

D.O.B:

PIT CREW DETAILS

*Please note 1 x pit crew member is included in the entry free. A fee of $20 will be charged for each additional crew member up to a maximum of 4 additional (5 in total).

NAME #1:

NAME #2:

NAME #3:

NAME #4:

NAME #5:

CAR DETAILS

CAR MAKE AND MODEL:

YEAR:

REGO:

ENGINE: CAPACITY:

POWER:

DATE TIMES:

The event will be held at Cootamundra Airport on Saturday May 11th, 2013 from 7:00am until 5:00pm.

Scrutineering and accreditation will be open from 7:00am until 10:00am. All drivers and pit crew must complete the accreditation process before 10:00am. Late arrivals will not be allowed to participate in on track activities.

All drivers are required to attend a briefing at 9:00am. Due to insurance policy regulations, drivers who miss the briefing will not be allowed to participate in on track activities.

LOCATION DIRECTIONS:

The event will be held at Cootamundra Airport in Cootamundra, NSW. Cootamundra is approximately 4 hours from Sydney and 1 hour from Canberra. Follow the Hume Hwy to the Coolac/Cootamundra exit (large overpass). Cootamundra is 25-30 minutes from the exit.

ACCOMODATION & MEALS:

Drivers and pit crew are responsible for their own accommodation and meals. There is a Woolworths, Caltex service station and a Repco in Cootamundra.

PIT CREW:

One (1) pit crew member is included in the price of entry. A fee of $20 will be payable for each additionalpit crew member up to a maximum of 4 additional per driver (5 in total). The behaviour of all pit crew is the responsibility of the driver. Any pit crew or driver who behaves in a disruptive manner or fails to comply with staff instructions will immediately be ejected from the airport.

All pit crew must arrive and be accredited at the same time as the driver. All drivers and pit crew must sign an indemnity form prior to partaking in on track activities.

Under the insurance policyonly registered drivers and pit crew are permitted on airport grounds. General spectators are not permitted.

Please remember that motorsport is dangerous and entry is at your own risk

JET MULTIMEDIA

Po Box 7083 Silverwater NSW 2128

ABN:26147106849

TAX INVOICE

Entry to 2013 Motive Airport Thrash

Early Bird Rate (payment made prior to COB March 31)$130incl GST

Standard Rate (payment made after COB March 31)$150 incl GST

Each additional pit crew member$20

Please complete the below:

Rate (please circle)Early Bird ($130)Standard ($150)

Number of additional pit crew______

Total payment______

Payment can be made by E.F.T. or credit card.

BANK DETAILSCREDIT CARD DETAILS

Account Name: Jet MultimediaName on Credit Card: ______

BSB: 062-714

Account No:1001 2834Credit Card Number: ______

Credit Card Expiry: ______

Signature: ______

* Entries close May 1. Payments and entry forms received after this date will not be accepted.

* Jet Multimedia does not share credit card information outside of its accounts department.

PLEASE SEND YOUR COMPLETED ENTRY FORM TO:

Email: ;

Post:Jet Multimedia

PO Box 7083

Silverwater 2128