Email *
E-Mail *
0 points
We will participate in the event from FRIDAY to SUNDAY (CAMPING INCLUDED): R850 (4 PAX) : R60 ADD/PERSON (MAX 6 PAX)  *
Required
We will participate in the event only the SATURDAY (CAMPING NOT INCLUDED): R250 (4 PAX) : R60 ADD/PERSON (MAX 6 PAX)  *
Required
Name and Surname of DRIVER (responsible for the account):
*
Contact number of PRINCIPAL participant:
Bakkie Model (eg. Hilux/Land Cruiser/Ford etc) & 1st Year of Registration ie. 1975/2022 etc:
*
ODOMETER Reading: *
WHERE will you be TRAVELLING from & DISTANCE (ie. KM): *
Name of DRIVER of 2nd BAKKIE (not the same as PRINCIPAL Participant) - IF APPLICABLE:
2nd BAKKIE: Model / Year of Registration / ODOMETER READING ie. 1975 / 201 000 - IF APPLICABLE:
 Name of DRIVER of 3rd BAKKIE (not the same as PRINCIPAL Participant) - IF APPLICABLE:
3rd BAKKIE: Model / Year of Registration  / ODOMETER READING ie. 1975 / 201 000 - IF APPLICABLE:
Name of DRIVER of 4th BAKKIE (not the same as PRINCIPAL Participant) - IF APPLICABLE:
4th BAKKIE: Model / Year of Registration / ODOMETER READING ie. 1975 / 201 000 - IF APPLICABLE:

Name of DRIVER of 5th BAKKIE (not the same as PRINCIPAL Participant) - IF APPLICABLE:
5th BAKKIE: Model / Year of Registration / ODOMETER READING ie. 1975 / 201 000   - IF APPLICABLE:
A copy of your responses will be emailed to .
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