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    Online Entry: 2017 V 4 & Rotary South Island Champs | Both Days

    Please read through the driver information on our website before completing this form.

    We recommend using Google Chrome or Firefox to complete this form.

    ENTRANT DETAILS

    First Name:(*)
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    Surname:(*)
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    Address:(*)
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    Town:
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    Contact Number:(*)
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    Email Address:(*)
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    Age:(*)
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    Occupation:
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    Drivers Licence #:
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    VEHICLE DETAILS

    All competitors are required to upload an image of your car for our records and to use in our gallery of competitors. Images must be less than 2mb, and either pdf, jpg, png or gif format.
    Upload a picture of your car <2mb
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    Is your Vehicle Registered?(*)
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    Do you have a current WOF?(*)
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    Number Plate:
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    Make:(*)
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    Model:(*)
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    Year:(*)
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    Colour:(*)
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    Will vehicle be part of a Trade/Club Display? (*)
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    If so, which one?
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    ENTRY DETAILS

    After completing this form, you will be entered into the Indoor Show & Shine and all Saturday Track Sessions (OPTION 1).

    OPTION 1

    Includes access to Drifting, Circuit, Powerskids, Grasskhana, Burnouts, Hardpark and Cruising (all sessions)

    INDOOR Show/Track Entry Fee:

    Early Bird Entry: $160 (Available until 17th October)
    Online entry: $190 (Available 18th October - 15th November)
    Entry on the day: $210

    PREMIER Show/Track Entry Fee:

    Early Bird Entry: $280 (Available until 17th October)
    Online entry: $310 (Available 18th October - 15th November)
    Entry on the day: $330

    Entry fee covers 1 driver and 1 vehicle for Both Days (Saturday/Sunday).
    Entry Desired:(*)
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    Free Tshirt size:(*)
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    Have won at our event before?
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    If so can you please tell us what ones
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    We appreciate your entry and aspire to provide a friendly, exciting and safe experience.

    Indemnity: We advise that all activities do carry a degree of risk and that by participating in the activities provided, you are expressly assuming those risks personally and are releasing 4 & Rotary Promotions 2006 Ltd, Levels Raceway and land owners and their officials, representatives and agents (hereinafter known as the promoter) from any liability, claims, losses, damages or expenses caused by any event including, but not limited to:
    - personal injury or death – acts which may be constructed as negligent or accidental
    - property loss or damage – any other loss, damage, suffering, emotional or nervous disorder.

    In participating in the activity I agree to the conditions set out as above and consent to the conditions below:
    1(a) I agree that my successors, executors, administrators and next of kin are bound by these terms and conditions.
    1(b) I agree not to commence any litigation or proceedings in relation to the risks and perils set out in 1 above and to indemnify the Promoter against any such claims.
    1(c) I confirm that I am physically fit and suffer no medical conditions that could put me or another person at risk during this activity.
    1(d) I consent to receive medical treatment in the case of injury, accident or illness during that activity and to indemnify the Promoter against any claims in respect of this treatment.
    2. I agree that any films, sound, video or other recordings of or during the activity can be used by the promoter at it's complete discretion without prior approval.
    3. Refunds are entirely at the discretion of the promoter. No express or implied warranty of safety shall result from scrutineering checks.

    Scrutineering checks are intended to assist the competitor in his/her own safety checks and are in no way a guarantee against injury or death to a spectator or the participants. We will not share, sell, or rent individual personal information with anyone without your advance permission or unless ordered by a court of law. Information submitted to us is only available to employees managing this information for purposes of contacting you or sending you emails based on your request for information and to contracted service providers for purposes of providing services relating to our communications with you.

    Requirements for Show:
    WOF or Reg aren't required, however 3rd Party insurance is prefered as 4 & Rotary Promotions 2006 Ltd takes no liability for any damages or loss at the event.

    Conditions of Entry:
    All vehicles must be in a reasonable condition including neat and tidy presentation. Vehicles entered in the show are not permitted to start their engines or leave the halls until the event is closed. Keys must not be left in vehicle. Entrants must accept directions and decisions from all event officials, management, judges & fire wardens. No correspondence will be entered into. Judges decisions are final. Failure to comply with the conditions of entry will result in dismissal from the event and all entry entitlement canceled. No refund will be given.
    Entry fee will only be refundable if entry is withdrawn via email prior to 1st of November 2016 and an administration fee of $10 will be retained.

    Behavior:
    All entrants must conduct themselves in a civil and well-behaved manner at all times. 4 & Rotary Promotions 2006 Ltd reserves the right to refuse entry. Security will be in force all weekend and the police will be notified of the event. 4 & Rotary Promotions Ltd officials reserve the right to discipline or disqualify any person/s who behave in an irresponsible manner. Any person/s may be held responsible for any damage to property fittings/surroundings. Entrants are not permitted to conduct any business activity including buying/selling transactions, the display or distribution of promotional materials e.g. business cards, brochures, banners, for sale or company/promotional signs. 4 & Rotary Promotions 2006 Ltd will not be held liable for any loss, theft or damage to property, vehicle or persons resulting from the attendance of the event. 4 & Rotary Promotions 2006 Ltd have the right to deny access to any vehicle or persons into the event if they fail to comply to the conditions of entry. 4 & Rotary Promotions 2006 Ltd reserve the right to add or delete trophy categories or alter judging to suit each event, as they see fit. A full list of categories is available on our website.

    Advertising release:
    As a condition of entry, each entrant for themselves, as agent for accompanying adult and as parent or guardian for an accompanying child, grant the event promoter, 4 & Rotary Promotions 2006 Ltd, the exclusive right to photograph, video or film, or portrayal without names or credits as the event promoter may in their absolute discretion think fit.
    Acceptance Of Terms(*)
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    BILLING DETAILS

    Card Type:(*)
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    Direct Debit:
    Payments are to be made to "4 and Rotary Promotions"
    Account Number: 03-0179-0294140-002

    Please use your Number Plate as a Reference and Last Name as the Particulars.

    Payments are to be made within two working days from submitting this form.
    Name On Card:
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    Card Number: (no spaces)
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    Expiry ( MM/YY ):
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    Submit Entry
    After clicking the SUBMIT button you will be redirected to a new page to let you know your entry worked. Entries are not charged automatically! Processing usually takes 1-3 working days.

    Once we process and validate your entry and credit card details we will then confirm your entry via email and issue you with your registration number. Keep an eye on your Junk Folder too as these can often end up there.

    If you still see your entry form please check for errors in red.