Top End Rumble
TOP END RUMBLE 2017 ENTRY FORM
13th to 23rd June, 2017

Entries close on 31st March, 2017. NO entries accepted after this date.
NO ENTRIES AT THE EVENT.
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Entering with a 65 and earlier vehicle:             
A requirement of entry to this run is a pre '65 vehicle.
Darwin Club members who fall outside of this requirement please contact us for a restricted entry form which will allow you to participate in those aspects of the event not using a vehicle.


Upload Vehicle photo with entry:
Is the vehicle covered by Shannon's Insurance


Given Name:    Surname:

Street Address:    Suburb:    State:    Postcode:

Contact Number - Area Code:    Home:    Mobile:    Email:

Club:

Vehicle Year:    Make:    Body Style:    Rego Number:

Katherine Showgrounds camp site required from 11th June to 13th June ($10 per person, per night):

Sunday * $10.00
Monday * $10.00
Tuesday * $10.00

I am willing to use my open car to transport supercar drivers around the track in the processions at the Supercars at Hidden Valley Motor Sport Complex:


I will be participating in the grasskhana.( A slow event the very opposite of a go whoa):


Entry fee includes;
- Welcome sausage sizzle at official start of run Tuesday afternoon 13th June
- Show n shine evening of 13th June
- DJ Anthony and dancing at showgrounds or other venue if necessary 13th June
- Early Breakfast 14th June, 300km “far as the eye can see” run, Morning Tea 14th June, Photo op of cars in group on part of Australias History, Arrival at Darwin venue and welcome refreshments
- Music, dancing, movie night, cruise night, grasskhana, rockercover racing, Gala diner/dance 23rd June, Poker Run, displays, Polo Shirt, commemorative booklet, and merchandise
- 11 days of comraderie and cars and hot rodding fun, making the Top End Rumble in a laid back territory venue

ENTRY COSTS

Family (couple with children born after 31/12/2001)
2 Polo shirts only in this package, childrens shirts will be extra $35.00 each

Adults

Children

2 Adults and up to 4 Children

* $530.00
Shirt 1 Size Short Sleeve
Long Sleeve
Shirt 2 Size Short Sleeve
Long Sleeve

Young Adults (born between 1/1/1999 and 31/12/2001 part of family entry only)

* $100.00
Shirt 1 Size Short Sleeve
Long Sleeve
Shirt 2 Size Short Sleeve
Long Sleeve
Shirt 3 Size Short Sleeve
Long Sleeve

Couple
2 Polo shirts only in this package

* $455.00
Shirt 1 Size Short Sleeve
Long Sleeve
Shirt 2 Size Short Sleeve
Long Sleeve

Single Adult
1 Polo shirt only in this package

* $245.00
Shirt 1 Size Short Sleeve
Long Sleeve


Meal Options
Special Dietry Requirements: Gluten Free Quantity:
Vegan Quantity:
Lactose Intolerant Quantity:
Other: Quantity:


Extra Polo Shirts (Specify Quantity of each Size below) - Short Sleeve

* $35.00

Extra Polo Shirts (Specify Quantity of each Size below) - Long Sleeve

* $35.00

Total Amount $
Children Sizes (4,6,8,10,12,14)            Adult Sizes (XS, S, M, L, XL, XXL, XXXL, XXXXL)

Short Sleeve Polo Shirt Sizes (Enter Quantities).
Remaining =

Kids 4

Kids 6

Kids 8

Kids 10

Kids 12

XS (Kids 14)

S

M

L

XL

XXL

XXXL

XXXXL

Womens XS (Kids 14)

Womens S

Womens M

Womens L

Womens XL

Womens XXL

Womens XXXL

Womens XXXXL

Long Sleeve Polo Shirt Sizes (Enter Quantities).
Remaining =

Kids 4

Kids 6

Kids 8

Kids 10

Kids 12

XS (Kids 14)

S

M

L

XL

XXL

XXXL

XXXXL

Womens XS (Kids 14)

Womens S

Womens M

Womens L

Womens XL

Womens XXL

Womens XXXL

Womens XXXXL

I Agree I hereby release the organizers Top End Rumble Inc of any liabilities to vehicles and property, going to, whilst at or going from the Top End Rumble Rod Run.

IMPORTANT NOTE/CONDITIONS TO ENTRANTS:
- The Run Polo shirts will not be available for sale at the run. They must be pre ordered before 31/3/2017 @ $35.00 each.
- One single vehicle per entry form.
- No entries taken over internet after close date.
- Merchandise can only be purchased through entry form.
- If Polo shirt size is not indicated on the entry form then a large will be issued.
- No refunds will be issued for nonattendance. Entrants goodie bag will be posted out instead, after the event is over.
- Receipts with Entrant Number will be issued to every entrant. This must be presented at registration otherwise entry may be refused.
  Therefore, if you have NOT RECEIVED YOUR RECEIPT WITHIN 1 WEEK of sending in your entry please CONTACT JEAN ON MOB: 0406 072 718.
- Entrants ID and/or goodies bag can be collected by the entrant only.

- ENTRIES CLOSE 31st MARCH 2017.
- Entrant Information: Jean Wilson 0406 072 718 B.H.
- Email. mail@topendrumble.com

- If you are paying by cheque please print an extra copy of this page and click the submit button for address information and payment summary. You will need to send this form with your cheque.
- Cheques payable to Top End Rumble, and post to Top End Rumble, c/- PO Box 260, Berrimah. NT. 0828
- Direct Deposit: BSB: 065 901 Acct: 111 466 11. Please fill in “Direct Deposit Reference” with your full name so we can validate your payment.


NOTE: If you are paying by cheque, please print an extra copy of this page and click the submit button for address information and payment summary. You will need to send in a copy of this form with your cheque.

This form is copyright by Aplus I.T. Services Pty Ltd
For enquiries contact
mail@topendrumble.com