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: [email protected]
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