Under 70's Rod and Custom Club Inc.

October 14th to 16th at Bargara Beach Caravan Park

ENTRANTS DETAILS

Entrants Names:

Address:

City: Post Code: Phone:

Email: @

Club: City:

VEHICLE DETAILS

Vehicle Year: Make: Model:

Rego No:

Early Nomination cost ADULT-$45.00 each – CHILD-$25 each (10yrs – 17yrs) – Closes Mon 10th October

Please Note: Late Nomination cost is ADULT-$50 each – CHILD-$30 each (10yrs – 17yrs)

Includes

* Goodies Bag (1 per car entry only) * Saturday & Sunday Breakfasts * Friday night - BBQ Dinner

* Sat - Tour to Hinkler Hall of Aviation * Sat night - Catered Dinner and Live Band

* Car Entry to Sunday Car Show

REGISTRATION/ENTRY PER PERSON ………. @ $45 (or $50) $..................

CHILD (10 – 17 yrs) ………. @ $25 (or $30) $..................

TOTAL $

Sat Night Dinner Information: We will be having Wood Fired Pizza’s – there will be Vegetarian and Gluten Free Pizzas available. Please indicate number of persons requiring Gluten Free. Number Persons

By signing the Registration/Entry Form you agree to abide by the instructions of Rum City Rodders Inc. You further agree not to hold Rum City Rods & Customs Inc., it’s officers or members, or the ASRF liable for any loss or damage whatsoever, arising from any incident or matter which you, your vehicle or family or party may be involved in during the course of the Bargara Beach Campout and it’s associated activities. You also accept responsibility and liability arising from any incident or damage that you cause. ASRF Sanctioned Event: QLD SA 109-02-2011

Signature: Date: / / 2011

□ Please indicate if staying in Bargara Beach Caravan Park

NB: Mention the Campout when making your booking with the Caravan Park

Forward completed Registration Form and payment to: Rum City Rods & Customs Inc

P O Box 2112

BUNDABERG QLD 4670