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Online Entry & Payment Form
2012 Big River National Entry Form
13th – 16th APRIL 2012
RIVERLAND EXHIBITION CENTRE
BARMERA, SOUTH AUSTRALIA
Official Entry Form – please read conditions of entry before submitting. Sanction No: 12/01
ENTRIES CLOSE 1ST MARCH 2012-GOODIES BAG NOT GUARANTEED AFTER THIS DATE
Step 1 of 2
50%
ENTRANT DETAILS
Name
*
First
Last
Over 21
*
Yes
No
Address
Street Address
Address Line 2
City
State / Province / Region
Zip / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Northern Mariana Islands
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Phone
Email
ASRF Number:
Club (if applicable)
Adults:
Number of People Attending
Young Adults:
Young Adults 16-20 years
Children:
Children aged 5-15
ENTRANT VEHICLE DETAILS
Year
Make
Model
Reg. Number
Colour
Engine
ASRF Classification
Upload an Image of your Vehicle (max 3MB)
ENTRY FEES & CHARGES
per Adult Entrant (over 21 years)
Price:
$ 50.00
Quantity:
Adult Names
Young Adults (16-20 years)
Price:
$ 35.00
Quantity:
Young Adult Names
Children (5-15 years)
Price:
$ 10.00
Quantity:
Children's Names
ON-SITE CAMPING
On-site Camping is available at the Riverland Exhibition Centre
*Bring your own Accommodation*
On-Site Camping Costs - $25 per night
(max 4 adults per site)
Extra Campers $5 per person per night
Do you require on-site camping?
No
Yes
Camping Site (max 4 adults) Number of Nights
Price:
$ 25.00
Quantity:
Extra Persons Total Due
Extra Persons are charged at $5 per person per night.
Please enter the amount due based on these calculations.
Notes or Requests re: Camping
Big River Nationals Shirts
Adult BRN “Polo Shirt” and Kids T-Shirts are available for order (cost not included in entry fee)
ADULT BRN POLO SHIRT
Price:
$ 20.00
Quantity:
Adult Big River Nationals 2012 POLO Shirt (Embroidered Front - Print on Back)
Size(s) Required
Small
Medium
Large
X-Large
XX-Large
XXX-Large
Kids BRN T-Shirt
Price:
$ 15.00
Quantity:
Kids Big River Nationals 2012 T-Shirt
Kids Size(s) Required
4
6
8
10
12
16
Notes or Requests re: Shirts
Total Amount Due
$ 0.00
Total Amount Due includes:
Entry Fees
Camping Costs (if applicable)
Shirts Purchased (if applicable)
Terms and Conditions
VEHICLE TYPES ELIGIBLE FOR ENTRY Australian Street Rod Federation class Street Rods, Customs and Classics up to 1965. Also American and AustralianClassic and Performance cars including Street Machines through to 1972, this being the year of manufacture. ENTRANT REQUIREMENTS 1. Current full or street rod registration and third party insurance. These papers must be available on request. Definitely No Trade Plates allowed. 2. Current Driver’s Licence 3. Recent photograph of your car. This may be used for promotional purposes. 4. Refund: Only available if this form is withdrawn in writing prior to 1st March 2012. An administration fee of $25 will be retained. ENTRANT ENTITLEMENTS Each entrant will receive a Goody Bag containing Event sticker, Identification, access to all BRN activities, assorted other event orientated goodies. Polo shirts available at additional cost. Exclusive entrants only camping available at Riverland Exhibition Centre. Only Entrant’s vehicles will have access to camping area. GENERAL WARNING AND EXCLUSION LIABILITY All entrants and their families must conduct themselves in a civil and well behaved fashion. Unacceptable behaviour will not be tolerated and offenders will be ejected from the Riverland Exhibition Centre and their entry entitlements cancelled. In such cases NO REFUND WILL BE GIVEN. Motor sport is dangerous and may result in injury or death to the person/s and property damage. As an essential condition of entry, each entrant acknowledges that prior to entering the Riverland Exhibition Centre or any driving events, he/she had made him/herself aware of the danger as a participant or spectator and/or property owner and has accepted all risks. The entrant him/herself and as an agent for accompanying children, release and discharge absolutely the promoter, event sponsors and the Riverland Field Days Committee, their employees, contractors, representatives and agents from any liability arising from any circumstances whatsoever. ADVERTISING RELEASE As a condition of entry, each entrant grants the promoter and the ASRF the exclusive right to photograph, film or portray the entrant, their accompanying party and the entrant’s vehicle. The use of such photograph, film or portrayal, with or without names or credits, is at the absolute discretion of the event promoter and the Australian Street Rod Federation.
Declaration - Agreement to Terms & Conditions - I, the undersigned, declare that I have read and understand all the conditions of entry set out agree to abide by the same. I further agree to accept all direction and decisions made by event management during the course of the Big River Nationals. I have drawn the conditions to the attention of the family and other persons included in this form.
*
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