Teams Series 2023

Name your team
Where in the country are you coming from?
Please provide us with an email address to send your team an information pack
Entry is only confirmed once we have received payment (club bank account details will be emailed)
If you are bringing somebody that can marshal, please put their name here

Describe your vehicle so that we can identify it
Full name of the driver
Name of emergency contact
Phone number for Emergency Contact
You must be affiliated with the NZFWDA to compete
Full name of co-driver
Name of emergency contact
Phone number for Emergency Contact

Describe your second vehicle so that we can identify it
Full name of second driver
Name of second driver's Emergency Contact
Phone number for second driver's Emergency Contact
Full name of second co-driver
Name of second co-driver's Emergency Contact
Phone number of second co-driver's Emergency Contact

It is ACKNOWLEDGED and DECLARED that it is a CONDITION of ENTRY to this event, that ALL
persons having any connection with the Promotion, Organisation, and/or the Conduct of this
Event, including, but not limited to, the Levin 4x4 Club, the Owner(s) and Lessee(s) of the Land,
the Owner(s) and Lessees(s) of the vehicles, the Competitors, and all Officials, and others, are
ABSOLVED FROM ALL LIABILITY arising out of any action or accident, causing property loss or
damage, or personal injury, including death, howsoever caused, not withstanding that such death,
injury, loss or damage may have been contributed to, or caused by the negligence of the Levin
4x4 Club, or by any of their respective Officials, Servants, representatives, agents, or by any other

I DECLARE that I possess the standard of competence required for an event of the type to which
this Entry relates, and that the vehicle in which I will compete is suitable, and properly equipped
for the event, having regard to the course, type of terrain, and speeds which may be reached.

I UNDERTAKE that should I, at any time during this event, be suffering from any DISABILITY of
any kind, whether permanent or temporary, which is likely to detrimentally affect my control of the
vehicle, I will declare it to the Officials. Permission for me to participate, not withstanding my
disability, shall be given at the sole discretion of the Club.
The Club Reserves the Right to Accept or Reject any Entry Certification.
I CERTIFY that the details given on this Entry Form are correct, and I UNDERTAKE to inform the
Officials of any change in these details, or alterations to the vehicle, which may affect the eligibility
of myself, or the vehicle to compete in this event.

We the UNDERSIGNED have read the pages of this Entry Form and AGREE to be bound by them
and any ADDITIONAL SUPPLEMENTARY REGULATIONS which are issued for this event.

Enter Name