EmailMe Form - All Holden Day 2014 Entry Form

Unique ID
Name *
First Last
Email Address: *

Confirm Email Address:
Home or Mobile number: *
Provide Reference for Direct Debit:
$25.00 pre-paid or $35.00 on the day
Payments can be made to:
Please make Cheque or Money Order payable to: Toowoomba FX-FJ Holdens Inc PO Box 523, Toowoomba, 4350. Direct Debit Details available from the website under Club Menu. Please provide your name as a payment reference and advise the club od Direct Debit Payment.
*

Car Club:

Car Rego
Vehicle year

Vehicle model

Vehicle Colour
Choose which Class you wish to enter in: *
Please note below:
HSV, HDT and Pre '80 original unrestored vehicles judged as single class.
As Participating entrants, I agree to the following: *
I hereby release the Toowoomba FX-FJ Holdens and the organisers against any claims for injury or accident occurring during the All Holden Day. I also agree to abide by all rulings of the officials and conditions of entry. Judges decision will be final.
I have read the conditions of Entry and agree to the above conditions. *
Yes
No

Car Club:
Car Rego