2012 Online Officials Registration Form
Please fill out and submit this form to register as an official of the 2012 Scouts 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)
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
2012 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?

2012 Rally SA Official Experience:
2012 Role: Stage Commander/Location

What role would you prefer in 2012? Other:
Do you have a preferred location for 2012? 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 Test Day Recce
 Media Day Rally
Start 		Event
 Event Event
 Post
Event
Date
   Mon
25 July		 Tues
26 July 		Wed
27 July		 Thurs
28 July
 Friday
29 July		 Fri Night
29 July 		Sat
30 July 		Sat
Night 30
July		 Sun
31 July 		Mon
1-7 Aug
 


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 2012)  

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*)