Wufoo

Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Mobile Number

So we can keep you posted via SMS on news and updates
Entry Information

Family Entry includes 1 Shirt, 1 Goodie bag and Sunday Breakfast and entry for 4 people

Single Entry includes a shirt, goodie bag and Sunday breakfast and entry for 1 person

Entrant price does NOT include the drags on Saturday
Select Entry Type *
Family Entry $85 (2 Adults, 2 kids under 16) Single Entry $65
Additional Children $5

Additional children do not receive a shirt or goodie bag
Additional Adults $15

Additional Adults do not receive a shirt or goodie bag
Shirt size *
Small Medium Large X Large XX Large XXX Large

Additional shirts can be purchased at the event
Vehicle(s) Information

Enter up to 3 cars on the one entry form.

Yes they have to be a Chev!
1st Car Details (Year/Model)
Rego
2nd Car Details (Year/Model)
Rego
3rd Car Details (Year/Model)
Rego
Name of Car Club

If you're part of a car club let us know
Exclusion of Liability

By agreeing to this entry form, you abide by the instructions of the organisers of this event and further agree to release the 55-56-57 Chevrolet Club of Victoria Inc. of any liabilities to vehicles and/or entrants during the course of the event.
*
I agree to abide by the conditions of the event and the exclusions of liability as set out in this form
Payment Method

You can either pay by:

Direct Deposit - transfer the money to our account
Cheque - send us a cheque by snail mail.

Either way we'll send you back a receipt and Entrant sticker.
Select a payment method *
Direct Deposit Cheque in the mail

If you choose to pay online the form will re-direct to PayPal.

Details for Direct Deposit and Cheque payments will be shown.
Do Not Fill This Out

Wufoo Powered

Wufoo

Entry Information

Vehicle(s) Information

Exclusion of Liability

Payment Method