Forms

AUSTRALIAN POWER BOAT ASSOCIATION STANDARD ENTRY FORM

Event

Name of Event:

Date of Event:

Venue:

Class:

Parental Consent Information:

Name:

Address:

Relationship to Driver:

Driver's Date of Birth (child):

Phone Number:

Boat Information

Name of Boat:

APBA Race Number (painted on boat):

Length of Boat (in meters):

Class of Boat (Mono, Tunnel, hydro etc):

Engine make and model:

Engine capacity (cc's):

Engine seal number:

Annual Tech Inspection Number:

Cell Number (if applicable):

Any major changes or repairs due to damage since the annual tech inspection?

yes

Boat Owner Information

Name of Boat Owner:

Owners APBA Licence Number:

Owners State Boating Authority Boat Registration Number:

Owners State Boating Authority Boat Registration Expiry Date:

Owners Member Club:

Owners residential address (as appears on SPA registration form)

Owners Contact Phone Number

Owners Email Address:

Driver information

Name of Driver:

Drivers APBA Licence Number:

Drivers State Boating Authority Driver Licence Number:

Drivers State Boating Authority Boat Licence Expiry Date:

Drivers Member Club:

Driver residential address (as appears on SPA registration form):

Drivers contact phone number:

Drivers email address:

Drivers Helmet Manufacture:

Drivers PFD/Life jacket manufacture:

Emergeny Contact Person

Name:

Phone Number:

Relationship to Driver:

Any changes to drivers medical condition since annual APBA medical check

yes

If yes, have you obtained medical clearance to compete in this event

yes

General

Will you be parking a transporter in the pits (please tick)

yes

Entry Fee & Payment

Entry fee $0 (Pay securely by Credit Card / Paypal)