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LONDON-SYDNEY MARATHON 2004
ENTRY APPLICATION FORM
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| This form can also be downloaded as Acrobat PDF by clicking here |
[Please PRINT when completing this form]
| DRIVER |
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Name
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Address
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Tel
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Fax
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Email
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| SECOND DRIVER |
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Name
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Address
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Tel
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Fax
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Email
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| CAR |
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Make
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Model
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Year
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Engine cc
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Acceptance of an entry is at the organiser' s discretion and subject to available places
| OFFICE USE: |
Received:
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Accepted:
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Ref:
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ENTRY FEES AND PAYMENTS
| ENTRY FEE: |
PAYMENTS SCHEDULE: |
| The Rally $38,000
The Clowes Cup $36,000
Service Entry $30,000
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| On application |
US$ |
1,000.00 |
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On or before: |
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Acceptance of entry
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US$ |
3,000.00 |
30th April 2003
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US$ |
10,000.00 |
31st August 2003
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US$ |
12,000.00 |
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31st January 2004
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US$ |
Balance |
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Entries paid in full before 30th April 2003 will qualify for a discount of $2,000
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REMITTANCE ADVICE FOR ENTRY FEES
| Amount being paid NOW |
US $ |
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I enclose a cheque for the above amount
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Tick appropriate boxes and sign below to confirm payment using your credit card
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Please debit my credit card for payment of the above amount
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Signature
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Please debit my credit card for payment of future instalments on the due dates as shown above
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Date
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US $ CHEQUES Make cheque payable to TRANS WORLD EVENTS
CREDIT CARDS Credit card payments are subject to a 2% surcharge
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Name on card:
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Card Number:
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Expiry date:
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