Pursuit Entry Form

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

 

             17/18th April, 2010   (Aberfeldy, 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:

 

$260 (inc.GST)per Team of 1 vehicle

 

Includes all relevant maps

 

 

only Mastercard or Visa accepted for online payment; or pay on the day- only to pre approved entrants

$ 260.00

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.