Racing Number
ZOC Membership No.
P.O. Box 21358, VALHALLA 0137
Telephone: (012) 384-2299
Fax: 086 541 3912
email: events@zwartkops.co.za
………………
OFFICIAL ENTRY FORM
I hereby apply to compete in the event to be held on
RACE
ENTERED
24 May 2014 at Kyalami.
Extreme
Supercars
Thunderbikes
Brunch
Run
SuperHatch
Rosso
Challenge
A
B
C
D
E
111 Sports
& saloons
Kawasaki
ZX 10 Masters
Cup
(Mark with X)
CLASS
(Mark with X)
Masters
class
Formula
Vee
VW Challenge
Ladies
Class
ENTRANT / DRIVER / RIDER DETAILS
‘
SPONSOR
CAR RACE NR
DRIVER /RIDER
Comp. Lic. No.
Postal Address
Tel. No. (h)
Tel. No. (w)
Code
Fax. No.
e-mail:
Cell:
Domicile
Emergency Contact
Person:
Date of Birth:
Emergency. Tel.
VEHICLE DETAILS
Make of Vehicle
Type / Model
Year
Engine Make
Capacity
No. of Cyl.
DECLARATION/UNDERTAKING TO BE SIGNED BY EVERY ENTRANT / DRIVER / RIDER:
I/We have read and understood GCR’s 93, 94, 113, 121 and 122 of the MSA Handbook and signify my/our agreement to abide by these Rules by
signing this entry form.
Driver/Rider:
(Print)
Date
(Print)
Date
(Signature)
Parent/Guardian:
I being the lawful parent/guardian of the abovementioned competitor do hereby grant permission for him /
her to drive/ride in the abovementioned event)
Entry Fees
NATIONAL & NATIONAL CHALLENGE
CLUB CARS
CLUB BIKES
ZOC MEMBERS
2nd ENTRY – Same Car /Bike & Same Driver
: R1400.00
(Includes VAT, MSA levy)
: R1300.00
(Includes VAT, MSA levy)
: R1200.00
(Includes VAT, MSA levy)
: Discount of R50 on entry fee
: R300.00
ZWARTKOPS RACING CLUB
BANK ABSA
BRANCH
Northcliff
Account No 405-503-3680
Branch Code
334-705
FOR OFFICIAL USE ONLY
Date Rec.
Chq __ : Cash __ : Dep. __
Entry Fee paid R ………..
Log Book R __________
Page 1 of 1
Tickets collected
Extra Tickets R ________