MSS Safety Gorge Rallysprint - Enter the Event

1. Entrant Details
Entrant Name*
2. Entry Details Driver
Driver Name*
First Last
Mobile*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Car Club Name
Next of Kin name*
First Last
Next of Kin Mobile*
Next of Kin Email*
Next of Kin Relationship*
3. Entry Details (Co Driver)
Co Driver Name*
First Last
Mobile*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Car Club Name
Next of Kin Name*
First Last
Next of Kin Mobile*
Next of Kin Email*
Next of Kin Relationship*
4. Entry Details (Additional)
All Event Correspondence To?*
- Driver
- Co Driver
- Entrant
- Other
*please note this will also be the postal address your Rally Box is sent to. Someone must be able to sign for the package
Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
5. Competition Vehicle Details
Make*
Model*
Year*
Registration No*
Category*
6. Service Crew Chief
Name*
First Last
Mobile*
Email*
7. Entry Fees
Entry For*
- Challenge $ 950.00
- Competition/cat S $ 1,150.00
Early bird prices shown ($200 discount). After 1 August, prices will return to normal
Entry fee
Additional Road Book & Map Set $ 30.00 AUD
Price: $ 30.00 Quantity:
Extra Event Map/s $ 10.00 AUD
Price: $ 10.00 Quantity:
Extra Road Book/s $ 25.00 AUD
Price: $ 25.00 Quantity:
Total
$ 0.00
8. Payment Options
Payment via?*
- Credit Card (VISA or Mastercard Only)
- EFT
Credit Card (VISA or Mastercard Only)
To make payment via credit card please contact Ivar on 0418 834 311
EFT
Payment Via EFT:
BSB: 065 005
ACC: 10125410
Account Name: Rally SA
*please use Drivers surname as the reference and email payment advice to [email protected]
Mandatory Documents
All documents may be scanned and emailed to [email protected] – and if that is done, there will be no need to present these documents any further.

Crews are to present the following documentation via scan (preferred) or at Scrutiny
- – Motorsport Australia licences (Driver, Co-driver)
- – Motorsport Australia Club Membership Cards (Driver and Co-driver)
- – Vehicle Registration
- – Motorsport Australia Logbook
- – Civil Licence (for the Driver)
Motor racing is dangerous
Declaration*
- MOTORSPORT IS DANGEROUS: Motorsport Australia and its associated entities exclude all liability for your harm howsoever arising from your attendance at the event except to the extent prohibited by law. Read the full disclaimer here.
  By submitting this form, you accept these conditions and are deemed to have signed this waiver.
Phone
This field is for validation purposes and should be left unchanged.

MSS Safety Gorge Rallysprint - Register as a Competitor / Enter the Event

1. Entrant Details

2. Entry Details Driver

3. Entry Details (Co Driver)

4. Entry Details (Additional)

5. Competition Vehicle Details

6. Service Crew Chief

7. Entry Fees

8. Payment Options

Credit Card (VISA or Mastercard Only)

EFT

Mandatory Documents

Motor racing is dangerous