This Form Is to Be Forwarded with Required Payment

APPLICATION FOR ENTRY

THIS FORM IS TO BE FORWARDED WITH REQUIRED PAYMENT

To Email:

TITLE: ______FIRST NAME: ______SURNAME: ______

STREET ADDRESS:______

______STATE: ______P/CODE: ______

PHONE:WORK: ______HOME: ______

MOBILE: ______EMAIL:______

CAR DETAILS:MAKE: ______MODEL: ______YEAR:______

REGO No:______Bash car or Family car: ______

Having a good time as well as fundraising is the heart of Fundraising with Variety the Children’s Charity.We are looking forward to bigger and better things in 2018. The Brats Bash is an event for the whole family, Mums, Dads, Aunties, Uncles, Cousins or Grandparents! The only prerequisite is the ability to have fun and enjoy yourself.
So grab a group of like minded friends or family and set yourselves a goal to raise a minimum of $500 per car and we will see some amazing results this year.
It is a privilege to call you all our friends and making a difference in someone else’s’ life is a bonus.

Entry feefora weekend of fun:

Adults:$199.00 ($25 entry fee plus $174 donation) per person

Children (15 years & under): $99($10 entry plus $89 donation) per person

Ages of Children ______

This will include

Breakfast Sunday & Monday Mornings.

Lunch & DinnerSaturday &Sunday Nights.

Accommodation isavailable (at your own expense)

Please contact us for more information.

We will provide you with a car number if you are not using a bash car. For those of you that are not using a bash car you MUST have a hand held UHF!!

DECLARATION

I understand that acceptance of entries in the 2018Brats Bash is at the absolute discretion of Variety Queensland Inc. and that receipt of this Application Form does not guarantee a place on the 2018 Brats Bash. I also understand that my crew members and I enter entirely at our own risk and that we will each sign an Indemnity Form prior to the event that will also include permission to receive marketing and promotional material/information from Variety Queensland Inc. as well as permission to include any photography/film footage of me and orcrew.

Signed: ______Date: ______

Payment Options: Please fill in and circle the type of credit card option you require

(a)Cheques are to be made payable to ‘Mark Anthony Smith Variety ’

(b) Please deduct the amount of $______from my credit card.

Master Card  Visa  American Express 

Card Number///Expiry/

PRINTED NAME ON CARD:______SIGN:______