Entry Form 2012

Dear Friends,

This Visitors Form is for non members only. Members will fill out a Members only form.  If you have not received a Members Form, then you are currently not a member, and need to complete this Entry Form.  If you wish to become a member for 2013, Application for Membership Forms will be available at the Treasurer’s Office during race week.

 

  • Race dates are 6th and 7th July, 2012.
  • Entry Fee is $110 per person.
  • Entry Fee for Pensioners is $77 – Proof of pensioner status is required with payment.
  • All school age children and Licensees are free.

PAYMENT OPTIONS:

  • No electronic payments after 30 June 2012.

 

Direct Bank deposit:

  • Account details – Oak Park Race Club Inc, Westpac, BSB 034160 – Account Number 701696
  • Use your name as your reference and advise Treasurer of payment
  • Return completed Visitors Entry Form to the Treasurer.

 

Cheque payment:

  • Cheque/Money Order payable to Oak Park Race Club Inc
  • Post payment and completed Entry Form to the Treasurer.

Payment on Arrival:

  • Payment at the gate is acceptable.

EARLY BIRD INCENTIVE:

 

The “Early Bird” draw for two free entries in 2013  is being offered again this year.  All forms filled out correctly, signed, and in the hands of the Treasurer before the 22 June, shall be eligible to be in the “Early Bird Draw” for 2 free entries for 2013.  This will be drawn at the Presentation on Saturday night, 7thJuly, 2012.

This Visitors Entry Form is available to print from the website www.oakparkraces.com.au or please copy the enclosed form if you need to.  A copy of the updated Ground Rules is also available on the website under “Frequently Asked Questions”

Alison Murphy

Hon Treasurer

Oak Park Race Club Inc

“Clothes Peg”,

Hughenden QLD 4821

Phone (07) 4741 7171

Email  clothespegstation@bigpond.com

ENTRY FEE DETAILS (For Visitors Only)

Please complete and return to the Treasurer before 22 June, for entry into the “Early Bird Payment” Draw

First Name (Person 1)

Surname (Person 1)

First Name (Person 2)

Surname (Person 2)

First Name (Person 3)

Surname (Person 3)

Postal Address

Postcode

Email

Phone Number

Vehicle Registration

Full names of any children for whom you are responsible

Full Name (Child 1)

Date of Birth (Child 1)

Full Name (Child 2)

Date of Birth (Child 2)

Full Name (Child 3)

Date of Birth (Child 4)

Please confirm that you have read and accept the ground rules and are responsible for the actions of all of the children in your care.

Required
 I Accept that I am responsible for the children in my care, and that I have read the Oak Park Race Ground Rules.

Amount Paid ($110 Per Person, $77 For pensioners with proof)

Camp Name

To be in the Early Bird Draw you need to return this completed form to reach the Treasurer before 22 June, even if you have paid electronically. This prize is not transferable or redeemable for cash.