EmailMeForm
V.S.B.C Online Entry Form
Online entries close the Wednesday prior to the meeting date.
**A late entry fee is payable for entries submitted less than 14 days prior to the meeting date.**
BEFORE YOU FILL IN THIS FORM PLEASE NOTE: Payment is by PayPal .
You must be ready to pay before pressing Submit Entry.
No Payment - No Entry - No Exceptions
**No entry fee payable for Interstate competitors **
Event information sheet is available from www.vsbc.org.au or click on the picture.
Name of Event
*
I.e Club Day, Eppalock Gold Cup, Kilos
Meeting Date
*
DD
/
MM
/
YYYY
Boat Name
*
Class Entered
*
Please select
Unlimited Outboard, F1, F/O
GP Hydroplane
Unlimited Displacement
Hydro / KT
F2 / SST120
6 Ltr Displacement
6 Ltr Hydroplane
Superstock 105mph
5.2 Ltr Displacement
4.2 Ltr Oz Boats Inboard
2700 Super Sports OB
95 mph
85 mph
Sports Mono / Mod VP
2100 Super Stock OB
1800 Super Sport OB
1.6 Litre OzLites
F3 / 1250cc
F4
25hp / Yamato / 550cc Outboard
Formula Future
Please select your appropriate class
Hull Type
*
Inboard Displacement
Outboard Tunnel
Outboard Mono
Hydro / KT
Formula Future
Inboard Only.
Unlimited
Injected
Carby
Restricted
Does your boat have a cell
*
Yes
No
Boat Registration No
*
Boat Registration Expiry
*
DD
/
MM
/
YYYY
APBA Race Number
*
APBA Log Book Number
*
Owners APBA Licence No
*
Owners APBA Club
*
Owners Name
*
First
Last
Owners Phone No
*
Owners Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Owners Email
Emergency Contact name
*
First
Last
Emergency Contact Phone No
*
Drivers Name
*
First
Last
Drivers Phone No
*
Drivers Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Drivers Email
*
Drivers APBA Club
*
Drivers APBA Licence No
*
Drivers SBA Licence No
*
Drivers SBA Licence Expiry Date
*
DD
/
MM
/
YYYY
Emergency Contact name
*
First
Last
Emergency Contact Phone No
*
Second Drivers Section
If applicable!
Second Drivers Name
First
Last
Second Drivers Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Second Drivers Phone No
Second Drivers Email
Second Drivers APBA Licence No
Second Drivers APBA Club
Second SBA Licence No
Second Drivers SBA Licence Expiry Date
DD
/
MM
/
YYYY
Declaration by Owners:
To the Honorary Secretaries of VSBC, I / We
*
Please insert owners name in the box above.
Being the owner/s of the above mentioned boat, do hereby enter that boat for the event noted above and
certify:
That upon my / our word of honour that the noted specifications of the boats hull and motor are known to
me / us to be in conformity with the rules and restrictions governing the class of the event and that I / we
will comply with rules & conditions.
I / we will not take legal action of any description against any party connected with the running of the event.
I / we further certify that all of the above particulars as noted are correct.
*
Clear
Owners Please sign in the box above
Date Owner Signed
*
DD
/
MM
/
YYYY
Drivers Signature
Drivers Signature.
NOTE I fully understand that all races will be started by VSBC officials, however the ultimate responsibility of starting & continuing in water conditions suitable for my driving & boat capabilities rests solely with me.
*
Clear
Driver please sign in the box above
Date Driver Signed
DD
/
MM
/
YYYY
Second Drivers Please Sign below if applicable.
Second Drivers Signature.
NOTE I fully understand that all races will be started by VSBC officials, however the ultimate responsibility of starting & continuing in water conditions suitable for my driving & boat capabilities rests solely with me.
Clear
Second Driver please sign in the box above.
Date Second Driver Signed
DD
/
MM
/
YYYY
Race fuel requirements. Please tick yes or no below.
Please contact Greg Holland for all fuel inquiries on 0417 519 194.
Price to be advised.
Will you need methanol or avgas ?
*
Yes
No
Approximate litres of Methanol required.
Approximate litres of Avgas required.
Are you an interstate competitor?
Please tick yes or no below, thank you.
Interstate Competitor
*
No
Yes
Payment Details.
Payment via PayPal only.
If paid on or before 10 days prior to the meeting date $160 for Seniors and $30 for Formula Future.
**No entry fee payable for Interstate competitors **
Entries submitted between 9 and 0 days prior to the meeting $220 for Seniors and $50 for Formula Future.
Safety Levy Payable
*
Please select
Seniors Entry
*Seniors Late Entry *
Formula Future Entry
*Formula Future Late entry *
Interstate Entry
If this entry is submitted between 0 and 9 days prior to the meeting then please select the late entry fee, thank you.
VSBC OLE 2017
Total
$0.00
