"Navrun After Dark"

Entry Form

"use this form below to electronically submit, for other methods just print out this form"

August 21st /22nd, 2010 @ Rushworth , VIC

Team name :

Team postal address:

Team email address: (Will email instead of post)

Optional 2nd Email address:

Telephone number with contact name:

Vehicle's Name
Driver
Navigator
Total cost is: $220 Fee includes all notes and maps. *"entry fee does not include dinner; For only an additonal $5 a head, Aussie Disposals will provide you with dinner"*			Mastercard / Visa accepted for payment or pay on the day $ 220.00 If you require dinner, please pay this seperately on the day of checking in your team. This also includes any extra passengers you bring along, etc
Credit Card Number
Expiry Date
Account Name

OR: Post to Paoletti's Maps to 15 Nirvana Close, Langwarrin South Vic, 3911.

Or Fax your entry form to (03) 9776 6798 or Telephone 0428 534 102.