Registration Form
(Entry restricted to 1932 vehicles. One form required per car)
Deuce Days 2019 Sponsored by JRI Insurance
Name
Your answer
Address
Your answer
Email
Your answer
Phone
Your answer
Car Registration #
Your answer
Body Style
Club
Your answer
Adult 1 Name
Your answer
Adult 1 Registration Fee
Adult 2 Name
Your answer
Adult 2 Registration Fee
Adult 3 Name
Your answer
Adult 3 Registration Fee
Child 1 Name
(5-12 years old)
Your answer
Child 1 Registration Fee
Child 2 Name
(5-12 years old)
Your answer
Child 2 Registration Fee
Pre-Schooler names
(0-4 Free)
Your answer
Dress Shirt - $65
(Select sizes desired. If requiring multiple of one size please tick 'other' and advise in comments field below. Note: Extra shirts will NOT be available at the event)
Event T Shirt - $30
(Select sizes desired. If requiring multiple of one size please tick 'other' and advise in comments field below. Note: Participants price with registration only. Extra T shirts will be available for sale to the public at the event but at $40 each)
Event Ladies V neck T Shirt - $30
(Select sizes desired. If requiring multiple of one size please tick 'other' and advise in comments field below)
Accommodation
Accommodation is at the host venue (Copthorne Solway Park), and is at a heavily discounted flat rate of $145 per night. Rooms are being allocated in order of receipt of registration and can only be booked with entry. If you wish to stay on the Thursday and/or Sunday nights, please note in the comments box and we will arrange for you.
Total Registration fee payable
(Please tally up selections above and note the total of Adult Registration fees $200pp; Children fees $150pp; Dress Shirts $65ea; T Shirts $30 ea; Accommodation deposit $50)
Your answer
Payment of Registration Fee
Credit card details
Please provide card number, expiry date & CVV security number (or ring 06-3775706 with details)
Your answer
Comments/Queries
Your answer
Submit
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