MG Motoring 2016 - Page 47

July 2016 ENTRY FORM. 2016 KIMBER RUN SUNDAY 21 AUGUST ENTRIES CLOSE FRIDAY THE 12TH OF AUGUST This entry form is required to be completed and the “Conditions of Entry” must be signed as acknowledgement of such conditions and forwarded with appropriate fee together with a stamped self-addressed envelope. or your email address for your confirmation of entry Entry costs: A registration fee of $25.00 per vehicle applies. A further $41.00 per person is payable to cover the cost of morning tea & a sit down lunch at Murray Bridge. Entrants & Vehicle Entry Details: NAME:………………………………………………..................…TELEPHONE:............................ ADDRESS:…………………………………………………………………………...................... POST CODE.................... EMAIL ADDRESS:………………………………………………… CAR: ….……………………… MODEL:………………………..YEAR:……………………….. REGO NO:. ……………. ………….. COLOUR:…………………… NOTE: Entry is subject to the Conditions of Entry, which must be signed by the owner / driver in acknowledgement of these conditions. Payment Arrangements: Registration @ $25.00 $........................... Number of Meals …………@ $41.00 / Person $....................... Total $..................... Payment by; ( Circle) CASH / MONEY ORDER / CHEQUE or CREDIT CARD If paying by Credit Card (Please Circle) (1) MASTER CARD or (2) VISA Card Number: Special meal requirements………………………………………..No.Req”d........ Card Holders Name………………………………………Card Expiry / / Card Holde rs Signature:................................................................. Please make all Cheques & Money Orders Payable to: MG Car Club of SA Return completed entry forms to: 2016 Annual Australian Kimber Run C/- MG Car Club of SA Inc PO Box 200, Brompton SA, 5007 Together with a STAMPED SELF ADDRESSED ENVELOPE PLEASE!! OR YOUR EMAIL ADDRESS in legible writing (do not use upper case writing if your address is in lower case) Any further information please contact: Allan Semmler, Kimber Run Coordinator by phone at home on 8266 2561 or Mobile 0418831027 or by email: asemmler@adam.com.au 45