2010 Online Officials Registration Form
Please fill out and submit this form to register as an official of the 2010 Rally SA.
Questions marked in bold are compulsory

Contact Information
Title: Home Phone:
Firstname: Work Phone:
Surname: Fax:
Address: Mobile:
Suburb: Email:
State, Postcode Please provide at least one contact number.
Occupation:
Age:   Under 18? Yes No Date of Birth:
(must be completed if U18)
Would you prefer a Beanie or Cap?:  
   
Car Club Member: Yes No If yes, which club?

*Can you be contacted to assist with other Events? Yes No


Experience & Preferred Role:
Have you been contacted for the 2010 event? Yes No
If yes, by whom (Stage Commander/Senior Official)
For Role: Location:

Previous Rally Official Experience:
Rally SA: Yes No  If yes which years?
Classic Adelaide: Yes No  If yes which years?
Other: Yes No  If yes what experience?

2009 Rally SA Official Experience:
2009 Role: Stage Commander/Location

What role would you prefer in 2010? Other:
Do you have a preferred location for 2010? Yes No  If yes where?
Do you want to be placed with other officials? Yes No  If yes who?
 
 


Availability

Please select the days that you are available: (NOTE: Daytime Hours Only unless indicated)

Activity

 Pre Event Test Day Test Day Recce

Recce

 Media Day Rally
Start 		Event
 Event Event
 Post
Event
Date   Tue
22 June		 Wed
23 June 		Thurs
24 June		 Friday
25 June
 Friday
25 June		 Fri Night
25 June 		Sat
26 June 		Sat Night 26 June

Sun
27 June

Mon
28 - 30 June
 


Additional Information

Are you a CAMS Licenced Official?: Yes No

Your CAMS Licence Details:
CAMS Licence Number   
CAMS Licence Types    
Expiry Date of Cams Licence (eg. December 2010)  

Do you intend to camp out in the forest on Rally Weekend? Yes No
Are you familiar with A to A timing? Yes No


Emergency Information
Contact: Name:
Relationship:
Phone:
 
Medical:

(a) Do you suffer from any pre-existing medical conditions we need to be aware of? Yes No
If yes, please provide details
(b) Are you presently on any medication we need to be aware of? Yes No
If yes, please provide details
(c) Do you suffer from any allergies we need to be aware of? Yes No
If yes, please provide details



Privacy Statement
All information supplied on this form will be entered into a database for the purposes of managing the Rally SA and will not be disclosed to third parties without the specific consent of the person concerned. (please refer to tick box*)