Work Phone: I am happy for my contact number and address to be circulated to other Variety entrants? Work Phone:

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Piers Rich
5 years ago
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1 2019 4WD Adventure: Parachilna to Laura 6-12 April 2019 Team Registration Form Primary Contact (Crew Captain): Car Number Crew Member #1:

2 Crew Member #2: Crew Member #3:

3 Vehicle Details Make: Model: Year: Registration No: Fuel Type: Tank Capacity: Range: Tyre Size: Event Costs Entry Fee $550 + Minimum Donation $7,000 + Event Participation - per person (TBC) Team with 2 crew members: $550 Entry Fee - Return with this form (non refundable and non transferrable) *Please note: Until the Entry Fee is paid your 4WD entry is not guaranteed + $7,000 Minimum Donation - Payable by Entrant Briefing Night (Date TBC) *This money is used to directly benefit the work of Variety SA. + (TBC) Event Participation fee - (Per crew member) - Must be be paid prior to, or at the Event Launch in September (Date TBC) to secure your position. This includes: Meals, merchandise, entertainment, accommodation (where available) along with nightly sunset parties are included in the provisions fee, which is a cost payable per person. Additional crew members: $1,500 per additional crew member - Required for each additional crew member. Payable via sponsorship or fundraising. Summary: $7,550 - Vehicles with 2 crew members ($550 Entry Fee (GST inc) + $7,000 Minimum Donation) $1,500 - Each additional crew member (max team of 4) (TBC) - Event Participation Fee- per person

4 Payment Details Amount: ($) 1. Cheque / Money Order / Cash returned with this form 2. EFT: BSB Account No: Ref: 4WD19 Car# Card Number: 3. Credit Card Online: Go to our website Click on the Donate button Expiry Date: Name on card: Type 4WD19/CAR # into the comments field Fill out your personal details Click Submit. You will be taken to the secure payment page, where you can enter your Visa, MasterCard or Amex details. 4. Credit Card (by Fax or Post only to ensure security of your details) Card type: Visa AMEX Mastercard I acknowledge receipt of the conditions of entry and code of conduct. I agree to observe these conditions and all the subsequent amendments and additions. Failure to observe these conditions of entry and code of conduct may lead to cancellation of entry. There will be a limited number of entries on the 4WD Adventure. You will be advised if your application has been successful. Variety may in its absolute discretion cancel the application of any entrants or crew member at any time prior to or during the 4WD Adventure. ALL entries are accepted at the Chairman s absolute discretion. Signature: (Team Leader) Print name: (Team Leader) Date: Please return this form together with your entry fee of $550 to Variety - the Children s Charity a: 68 Richmond Road, Keswick SA 5035 t: f: w: varietysa.org.au e: ally@varietysa.org.au Office use only: Amount ($) Date received: Authority to fundraise sent. Receipt No. Car No.

5 Conditions of Entry 1. The Variety office shall select those of the Applicants who are to join the 4WD Adventure. The criteria for selection will be as determined by the Variety Office from time to time. The Variety Office shall not be required to give any reason for the non-selection of the Applicant and no correspondence will be entered into. 2. Entrants taking part in the 4WD Adventure in any way must sign an Indemnity Disclaimer form supplied by the Variety office. 3. The Entrant indemnifies Variety against any penalty or liability Variety may incur as a consequence or action of the Entrant. 4. In addition to the registration fee of $550 (including GST), Entrants must procure further contributions (including donations) of at least $ , during the year but no later than one month prior to the Event. 5. At all times entrants must abide by the rules of the road as prescribed by State laws and statutes. 6. Entrants must observe all rules and regulations and vehicle specifications issued by the Variety office. 7. All entrants must comply with the 4WD Adventure Code of Conduct. 8. All entrants must read, understand and comply with the document entitled 4WD Adventure Rules & Regulations / Code of Conduct & Official Conditions of Entry supplied by the Variety Office 9. Entrants, crews and teams are not to operate bank accounts for the purpose of fundraising, using the name of Variety, Variety 4WD Adventure, 4WD Adventure Car or any combination. 10. Entrants, crews and teams are to have all public fundraising functions approved by the Variety office. Variety fundraising rules must be strictly adhered to and applied to all fundraising by entrants. Details are outlined in the 4WD Adventure Rules & Regulations / Code of Conduct & Official Conditions of Entry. 11. Variety SA reserves the right to conduct breath testing of drivers for blood alcohol and drug content. Anyone that refuses or fails to take a test will be immediately removed from the event. Anyone who exceeds the blood alcohol limit prescribed in the conditions of their drivers licence or tests positive for illegal drugs may also be immediately removed from the event. *THE 4WD CHAIRMAN S RULING ON ELIGIBILITIY IS FINAL. FURTHER CONDITIONS OF ENTRY MAY BE DRAWN UP BY THE ORGANISERS AND WILL BE RECORED IN THE MONTHLY FLIER UPDATE ISSUED FROM THE VARIETY OFFICE.

6 Code of Conduct (Short Form) 1. Entrants are to be aware that they will be seen as representatives of Variety South Australia and should behave accordingly. 2. Entrants will be instantly ejected from the 4WD Adventure, without warning, in the following circumstances: Actions that will compromise safety of the 4WD Adventure entrants and the general public Detection by the Police for driving while under the influence of alcohol (over.05 or legal limit in state) or drugs Offensive behaviour on a continuous basis Assault 3. Entrants may be ejected from the 4WD Adventure (for continuing transgressions) or refused entry to the next 4WD Adventure, after being given one warning, in the following circumstances: Bringing the name of Variety South Australia into disrepute Excessive drunkenness Tampering with other peoples cars or possessions Altering road signs or 4WD Adventure signs Vandalism Refusing to obey reasonable directions of Officials or organisers 4. Any entrant ejected from the 4WD Adventure will be automatically excluded from any future Variety Event (this includes events conducted by other states). 5. These provisions apply to all crew members and any transgression by an individual entrant will result in the exclusion of the crew as provided above. 6. Variety South Australia will not be responsible for costs incurred by early exclusion from the 4WD Adventure. 7. Above all, remember that the entrants are representatives of a CHILDREN S CHARITY.

V2 Motorcycle Run (2018):

V2 Motorcycle Run (2018): Car Entry Form 18 to 21 October Primary Contact: Car # Crew Member #2: 1 Crew Member #3: (Additional $1,500 fundraising required) Crew Member #4: (Additional $1,500 fundraising