Booking Request

Use this form to request booking for:

• OLT Observed Race Licence Test - COST: $400

After FULL PAYMENT is received, your request will be processed and confirmation with further details will be forwarded to you. As course numbers are limited and conditions apply, acceptance of your request is not automatic. You must receive our confirmation before the booking is firm.

Available Dates: see the Coarse Dates field below.

		NB: ALL fields must be completed
Dates		Choose Wed 3rd March 2010 Wed 7th April 2010 Wed 5th May 2010 Wed 16th June 2010 Wed 7th July 2010 Wed 4th August 2010 Wed 1st September 2010 Wed 6th October 2010 Wed 1st December 2010
Your Name
Address
Suburb		Postcode
Phone
Mobile
Email
Gift to		(optional name to appear on Gift Certificate if required)
Guests		(Lunch is supplied for you but $15 each extra for each guest you bring)
Vehicle Make
Vehicle Year
Engine Cap.
Race Car with Passenger Seat
Payment by		Credit Card  OR  Direct Deposit
Pay by Card		If paying by Mastercard OR VISA Card complete below. If Direct Deposit preferred, follow details further below.
Card Holder
Card Number		Expiry
		NOTE: All Credit Card Transactions will incur a 3.0% Surcharge, all prices displayed are in Australian Dollars (AUD) and include GST

Pay by Direct Deposit
Be sure to include a reference in the form stipulated here so that we can identify your payment.

Reference		(your surname)-OLT
Bank		Commonwealth
Account		Australian Racing Drivers Club
BSB		062-004
Account#		10086042

Copyright ^© 1999-2009 Australian Racing Drivers Club Limited. Ph: +61 2 9672-1000