Event Sign Up

Whangarei Rod & Custom Club INC

Mid Winter Run Event Sign Up

Event Date: 1st July to 3rd July 2022

Please use the online form below to register for this event.

Name

First Name
Last Name

Address

Street Address
Street Address 2
City	Region
Postal Code	Country

Phone
Email
Mobile
Name of Club
LVVTA Cert. No. or Stock Sticker No.
NZHRA Affiliation
Your Car
Year
Make
Model
Adults (Maximum 5)
# of Adults (Dormitory Room)
$130 per adult
# of Adults (Caravan / Tent)
$130 per adult
# of Adults (Family Room)
$160 per adult
# of Adults (Off Site)
$130 per adult
Total Adults
125
155
Dormitory & Caravan Total
Elite & Offsite Total
Total Adult Cost
Adult Name 1

First Name
Last Name
Adult Name 2

First Name
Last Name
Adult Name 3

First Name
Last Name
Adult Name 4

First Name
Last Name
Children (Age 5-14) Max 3
# of Children (Age 4-15)
$70 Per Child (Max 3)
70
Children Total Costs
1st Child's Name:

First Name
Last Name
2nd Child's Name:

First Name
Last Name
3rd Child's Name:

First Name
Last Name
Children (Age 4 & Under) (Max 3)
# of Children (4 & Under)
$0.00 Per Child
4th Child's Name:

First Name
Last Name
5th Child's Name:

First Name
Last Name
6th Child's Name:

First Name
Last Name
Full Cost total
Additional Comments
Total Costs: ${TotalCosts}

Please make this payment direct to bank account: ANZ 11-5000-0723762-11

Reference: Your Name and MWR

Contact: Debi Wright, Ph: 027 6782205
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Whangarei Rod and Custom Club