Wufoo

Rally Queensland 2009

Officials Registration Form

Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone (work)
Phone (Home)
Mobile
Email
Date of Birth if under 18 DD / MM / YYYY
CAMS Licensed
Yes No
CAMS Licence number
Expiry date DD / MM / YYYY
CAMS Grades
Emergency Contact
Emergency Contact Phone number
Medical Details

Allergies, medication, etc. This information will be given to the Event Chief Medical Officer and destroyed after the Rally.
Previous Rally Experience
Number of years involved with Rally Queensland
Will you be attending the Officials Training Weekend (including BBQ)?
Shirt Size
Availability
Recce - 5th and 6th May, 2009 Setup - 2nd to 4th May, 2009 Spectator Setup - 8th May, 2009 Media Day - 8th May, 2009 Start - Friday evening - 8th May, 2009 Heat 1 - Saturday 9th May, 2009 Heat 2 - Sunday 10th May, 2009 Post Event Clean Up - Monday 11th May 2009

Please check preferred boxes. Note: all dates are daytime except where indicated.
Role
Stage Teams (eg Control, Road Closures) SOS Spectator Areas Service Park Regroup / Parc Ferme HQ Course Cars Drivers (Clock / Blacktree) Drivers (Signage)

Please check preferences.
Other Role

Nomad, FIV, Wicen, Scrutineers, Refuel etc
Stage Commander / Stage Area (if known)
Spectator Marshall attending with
Do you have your own vehicle available to you during the rally?
If yes, is your vehicle suitable for gravel road conditions?
If yes, is it a 4WD?
Comments
Do Not Fill This Out