Hella High Country Entry Form

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

 

             2nd/ 3rd October, 2010   (Aberfeldy-Walhalla, VIC)

 

Team name :          

Team postal address:

Team email address:  (Will email instead of post)

Optional 2nd Email address: 

Telephone number with contact name:   

Driver:

Navigator:

 

Total cost is:

$300 (inc.GST)per Team of 1 vehicle

(inc. 2 x adult meal tickets)

 

Additional ONLY passengers for dinner

Adults and over 12 $25 each

Under 12 $15 each

 

Over 12

 

Under 12

 

Mastercard / Visa accepted for online payment; or pay on the day is accepted

Total Cost $

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.

You may also post cheque or money order to the above address. Made out to Paoletti's Maps