Old Entry Form

MAKE SMOKING HISTORY TARGA WEST

Please complete this form with all relevant details correctly formatted to ensure your entry is received.
Supp Regs can be downloaded from: www.targawest.com.au/noticeboard/
1. COMPETITION ENTERING
Please select which competition you are entering
2. DRIVER DETAILS
Has the DRIVER competed in any of our Targa West events (including Shannons Targa Rallysprints) in the last 18 months?
Do you suffer from any Allergies or are you taking any medications that may affect treatment should it be required in an Emergency (e.g. 'blood thinners')?

At documentation, please provide the Event Secretary with details of Medications contained in a sealed Envelope (labelled with your Name, Motorsport Australia Licence #, Date of Birth and Car #) to be passed on to the Chief Medical Officer

You are considered a Targa West Rookie if, as a Driver, this is your first year as a tarmac rally competitor. Please indicate if you are a rookie.

Please provide the Name and Mobile number for your next of kin in the event of an emergency.

3. CO-DRIVER DETAILS
Has the CO-DRIVER competed in any of our Targa West events (including Shannons Targa Rallysprints) in the last 18 months?
If you suffer from any Allergies or are taking any medications that may affect treatment should it be required in an Emergency (e.g. 'blood thinners')?

At documentation, please provide the Event Secretary with details of Medications contained in a sealed Envelope (labelled with your Name, Motorsport Australia Licence #, Date of Birth and Car #) to be passed on to the Chief Medical Officer

You are considered a Targa West Rookie if this is your first year as a tarmac rally competitor. Please indicate if you are a rookie.

Please provide the Name and Mobile number for your next of kin in the event of an emergency.

4. COMPETITOR

Please provide details of the Competitor, (previously referred to as "Entrant"), typically the Vehicle Owner. Refer NCR 43, 43A. The vehicle owner is the Person or Entity (in the case of a business) listed in the Motorsport Australia Logbook/Registration Papers.
Who is the REGISTERED Owner of the Vehicle?
(if applicable)

If the Driver is not the registered owner then a Letter of Authority is required from the Registered Owner allowing the Driver to compete using the vehicle and must be presented at Documentation.

A fillable PDF template can be downloaded from the Official Noticeboard on www.targawest.com.au/noticeboard

5. VEHICLE DETAILS
List one Sponsor to be named in lieu of the Entrant on the Entry List / Start Order etc. If not provided then the Entrant will be listed.
Where possible we will try and accommodate a request for a specific car number. Please indicate your preferred car numbers, in order of preference. Numbers must be within the range of 1 - 99 and preference will be given to competitors with recent Targa West history using the same number.
Are ALL your vehicle details the same as the most recent Targa South West or Targa West you entered?
Please nominate what Technical Regs your car complies with. You car must comply in its entirety with ONE set of Regs.

Rally Permits:
We have been asked to remind ALL competitors that when applying for an Over 48 hour Permit for their unlicensed Rally Car that you must allow 14 days for processing. In the past the Department have had the resources to process the applications quite quickly, however due to current workloads this is no longer the case and 14 days notice will be required. Also, note that the normal 48 Hour Permit that you can apply for online is NOT suitable for use during a rally and can not be used. The correct form can be downloaded from the Official Noticeboard.

Engine Capacity:
Remember to include the capacity equivalence factors of 1.7 if Turbo/Supercharged, and 1.8 if a Rotary.

6. RECCE & SERVICE CAR DETAILS

If known, please provide details of your Recce, Service Vehicle and Trailer/Transporter, otherwise leave blank for the moment and email the details to admin@targawest.com.au prior to the event.

Please provide details of the car you will be using during reconnaissance

Please provide details of the car your service vehicle.

Please provide details of your car trailer.

7. TEAM MANAGER & SERVICE CREW

Please provide details of your Team Manager, or other main contact, should we be unable to contact the Driver/Co-Driver during the event eg to organise vehicle recovery etc.
SERVICE CREW
Up to 8 crew including the Service Crew Chief are included in your entry. Additional crew can be registered at extra cost. Note: All Service Crew must sign the Motorsport Australia Disclaimer prior to the event. Please download a Service Crew form here (fillable PDF). Please present the completed Service Crew Form at Documentation
8. HEALTHWAY ACKOWLEDGEMENT

Targa West are committed to creating a healthier tarmac rally community and proudly promote Make Smoking History in association with Targa West events.

By participating in the event I confirm that ;

  • my car does not contain any tobacco branding, including but not limited to colour scheme/theme, logos, insignia, text.
  • our team wear including driving suits, helmets, shoes, hats, shirts etc does not contain any tobacco branding, including but not limited to colour scheme/theme, logos, insignia, text.
  • our team, including, driver, co-driver and all support/service crew, will not promote tobacco products or smoking and are aware of the Targa West Non Smoking policy

Note: Historic or Classic cars replicating colour schemes of the era may, upon application, be approved by the organisers on a case by case basis. Please seek permission (email: admin@targawest.com.au) prior to completing your entry.

9. SHANNONS INSURANCE

Shannons Insurance have a ever expanding portfolio of insurance products including Car, Bike & Home Insurance.

See www.shannons.com.au or call 13 46 46.

Shannons are fantastic supporters of motorsport in general but in particular of our Targa West, the Targa Rallysprint Series and all our other Targa West events.

We would encourage you to support those that support us.

Please indicate below whether you would like someone from Shannons to contact you to discuss your Car or Home Insurance needs.

10. PAYMENT DETAILS

Reminder: Your Entry Fee must be received in full prior to close of entries in order for your entry to be accepted.
Please advise the business name should you require a Tax Invoice to be supplied. Leave blank if an invoice is not required.

$4,650

$4,650

$4,650

$3,650

$2,750

$1,790

Please select your preferred payment method.

BSB: 066-160
Account #: 10484606
Ref: TW & Drivers Surname

Please contact admin@targawest.com.au to arrange a Credit Card Payment.

Please note a 1.5% Admin Fee applies to all Credit Card payments.

11. SUBMIT ENTRY
Thank you. Please check the boxes below and then click the Submit button once to complete your entry. A confirmation page will appear shortly.
Is there anything else you would like the organisers to know?
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