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Home
About
Events
Membership
Resources
Competitors
BSCC Club Shirt Order Form
Gallery
Officials
Motorsport Australia
Useful Links
Find us on Facebook
Constitution
Results
Magazines
Magazines: 2020 – 2024
Magazines: 2015 – 2019
Magazines: 2010 – 2014
Magazines: 2000 – 2009
Magazines: 1990 – 1999
Magazines: 1980 – 1989
Magazines: 1970 – 1979
Magazines: 1960 – 1969
Contact
The Lakes Hyundai BSCC Test & Tune
The Lakes Hyundai BSCC Test & Tune Entry Form
“Held under the FIA International Sporting Code including Appendices and the National Competition Rules of Motorsport Australia.”
DRIVER / COMPETITOR (Vehicle Owner)
*
First
Last
DRIVER - If not Vehicle Owner
First
Last
DRIVER Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
DRIVER Email Address
*
DRIVER Mobile Phone Number
*
DRIVER Civil Licence Number & Expiry Date
*
DRIVER Motorsport Australia Licence No & Expiry Date
*
DRIVER BSCC Car Club Member or REQUIRE Day Membership
*
DRIVER BSCC Car Club Member
Require day Membership of BSCC $20 - Deductable off Full Membership if taken up within 30 days
DRIVER Emergency Contact - Name and Phone No.
*
DRIVER - Camping - Jimna - Will incur a fee of $5 per night - payable in CASH to Jimna Recreational Club
*
Friday Night
Saturday Night
N/A
COMPETITOR DETAILS - Vehicle Owner (If Vehicle Driven by someone else) Name,Mobile and Email address
Will Entered Vehicle be driven by more than One Driver
*
No
Yes - Additional Drivers to pay another entry fee $110.00 incl GST
Additional DRIVER 1 - Name
First
Last
Additional DRIVER 1 - Address
Additional DRIVER 1 - Email Address
Additional DRIVER 1 - Mobile Phone Number
Additional DRIVER 1 - Civil Licence No & Expiry Date
Additional DRIVER 1 - Motorsport Australia Licence Number & Expiry Date
Additional DRIVER 1 - BSCC Car Club Member of REQUIRE Day Membership
BSCC Car Club Member
Require DAY Membership of BSCC $20 - Deductable off Full Membership if taken up within 30 days.
Additional DRIVER 1 - Emergency Contact - Name & Phone No.
Additional DRIVER 1 - Camping - Jimna - Will incur a fee of $5 per night - payable in CASH to Jimna Recreational Club
Friday Night
Saturday Night
N/A
Additional DRIVER 2 - Name
First
Last
Additional DRIVER 2 - Address
Additional DRIVER 2 - Email Address
Additional DRIVER 2 - Mobile Phone Number
Additional DRIVER 2 - Civil Licence No & Expiry Date
Additional DRIVER 2 - Motorsport Australia Licence Number & Expiry Date
Additional DRIVER 2 - BSCC Car Club Member of REQUIRE Day Membership
BSCC Car Club Member
Require DAY Membership of BSCC $20 - Deductable off Full Membership if taken up within 30 days.
Additional DRIVER 2 - Emergency Contact - Name & Phone No.
Additional DRIVER 2 - Camping - Jimna - Will incur a fee of $5 per night - payable in CASH to Jimna Recreational Club
*
Friday Night
Saturday Night
N/A
Navigator 1 - Name
*
First
Last
Navigator 1 - Address
*
Navigator 1 - Email Address
*
Navigator 1 - Mobile Phone Number
*
Navigator 1 - Motorsport Australia Licence Number & Expiry Date
*
Navigator 1 - BSCC Car Club Member of REQUIRE Day Membership
*
BSCC Car Club Member
Require DAY Membership of BSCC $20 - Deductable off Full Membership if taken up within 30 days.
Navigator 1 - Emergency Contact - Name & Phone No
*
Navigator 1 - Camping - Jimna - Will incur a fee of $5 per night - payable in CASH to Jimna Recreational Club
*
Friday Night
Saturday Night
N/A
Navigator 2 - Name
First
Last
Navigator 2 - Address
Navigator 2 - Email Address
Navigator 2 - Mobile Phone Number
Navigator 2 - Motorsport Australia Licence Number & Expiry Date
Navigator 2 - BSCC Car Club Member of REQUIRE Day Membership
BSCC Car Club Member
Require DAY Membership of BSCC $20 - Deductable off Full Membership if taken up within 30 days.
Navigator 2 - Emergency Contact - Name & Phone No
Navigator 2 - Camping - Jimna - Will incur a fee of $5 per night - payable in CASH to Jimna Recreational Club
Friday Night
Saturday Night
N/A
Navigator 3 - Name
First
Last
Navigator 3 - Address
Navigator 3 - Email Address
Navigator 3 - Mobile Phone Number
Navigator 3 - Motorsport Australia Licence Number & Expiry Date
Navigator 3 - BSCC Car Club Member of REQUIRE Day Membership
BSCC Car Club Member
Require DAY Membership of BSCC $20 - Deductable off Full Membership if taken up within 30 days.
Navigator 3 - Emergency Contact - Name & Phone No
Navigator 3 - Camping - Jimna - Will incur a fee of $5 per night - payable in CASH to Jimna Recreational Club
Friday Night
Saturday Night
N/A
COMPETITOR'S Disclaimer
To View Disclaimer, Exclusion of Liability, Release and Assumption of Risk. Competitor and Competing Crew and or Service Crew in Rallies - go to: www.motorsport.org.au
DISCLAIMER to be signed and returned electronically
*
We agree to Read and Sign Disclaimer
Disclaimer will be emailed to you for signing by Driver, Co-Driver & Service Crew and must be returned electronically to Secretary
DESCRIPTION OF COMPETITIVE VEHICLE
Vehicle Year
*
Vehicle Make and Model
*
Vehicle Base Colour
*
Vehicle Registration No & Expiry Date
*
Vehicle Log Book No
*
QLD 3rd PARTY INSURANCE COMPANY (Name of Insurer)
*
VEHICLE INFORMATION
*
N/A
Letter of Authority to drive Vehicle - If not vehicle Owner Driver
Rally Registration - copy of Authorisation to operate
DOCUMENTATION - as per Supplementary Regulations
*
I Agree to forward ALL Documentation via ELECTRONIS MEANS to Secretary
All Documentation has to be by ELECTRONIC Lodgement to Secretary
Service Crew 1 - Name
First
Last
Service Crew 1 - Email
Service Crew 1 - Mobile No
Service Crew 1 - Camping - Jimna - Will incur a fee of $5 per night - payable in CASH to Jimna Recreational Club
Friday Night
Saturday Night
N/A
Service Crew 2 - Name
First
Last
Service Crew 2 - Email
Service Crew 2 - Mobile No:
Service Crew 2 - Camping - Jimna - Will incur a fee of $5 per night - payable in CASH to Jimna Recreational Club
Friday Night
Saturday Night
N/A
Service Crew 3 - Name
First
Last
Service Crew 3 - Email
Service Crew 3 - Mobile No:
Service Crew 3 - Camping - Jimna - Will incur a fee of $5 per night - payable in CASH to Jimna Recreational Club
Friday Night
Saturday Night
N/A
Service Crew 4 - Name
First
Last
Service Crew 4 - Email
Service Crew 4 - Mobile No:
Service Crew 4 - Camping - Jimna - Will incur a fee of $5 per night - payable in CASH to Jimna Recreational Club
Friday Night
Saturday Night
N/A
TAX INVOICE - The Lakes Hyundai BSCC Test & Tune - Brisbane Sporting Car Club Ltd ABN: 18 010 180 266
Date
*
DD slash MM slash YYYY
Tax Invoice to:
*
Entry Fee Paid By:
*
Direct Deposit (EFT)
Credit Card/PayPal
Entry Fee
Entry Fee - Direct Deposit
$250.00 Test & Tune (Competitor/Driver)
$20.00 BSCC Day Membership (Competaitor/Driver)
$110.00 Test & Tune (Additional Driver 1)
$20.00 BSCC Day Membership (Additional Driver 1)
$110.00 Test & Tune(Additional Driver 2)
$20.00 BSCC Day Membership (Additional Driver 2)
$20.00 BSCC Day Membership Navigator 1
$20.00 BSCC Day Membership Navigator 2
$20.00 Road Book
Entry Fee - Credit Card
$256.25 Test & Tune (Competitor/Driver)
$20.60 BSCC Day Membership (Competaitor/Driver)
$113.30 Test & Tune (Additional Driver 1)
$20.60 BSCC Day Membership (Additional Driver 1)
$113.30 Test & Tune (Additional Driver 2)
$20.60 BSCC Day Membership (Additional Driver 2)
$20.60 BSCC Day Membership Navigator 1
$20.60 BSCC Day Membership Navigator 2
$20.60 Road Book
Total
$ 0.00
Upload documents,only one file covering licences, membership etc
Max. file size: 64 MB.
Upload Self Scrutiny form
Max. file size: 64 MB.
Upload Self Statement of Vehicle Compliance
Max. file size: 64 MB.
Upload Competitor Disclaimer
Max. file size: 64 MB.
Upload Service Disclaimer
Max. file size: 64 MB.
Upload Copy of Direct Deposit of entry fee (EFT) ENTRY FEE is payable with submission of Entry
*
Max. file size: 64 MB.
Email Address - copy of Entry Form to go to:
*
Please check your entry form before submission - if happy - hit the submit button
Thank you for your Entry The Organisers The Lakes Hyundai BSCC Test & Tune Brisbane Sporting Car Club Ltd
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