AWDC Safari Register 2013

All Driver information is required

Driver Name *

Full Address *

Postcode *

Contact Phone No *

Driver Date of Birth
dd/mm/yyyy or use date picker (...) ...*

Email Address *

AWDC Membership No
Please enter TBC if not available *

MSA License No
Please enter TBC if not available *

Emergency Contact Name

Emergency Contact No

Co Driver Information is not compulsory but useful for our records

Co Driver Name

Co Driver Contact No

Co Driver Date of Birth
dd/mm/yyyy or use date picker (...) ...

Co Driver Email Address

Co Driver AWDC Membership No

Co Driver Emergency Contact Name

Co Driver Emergency Contact No

All Vehicle Information is Required

Vehicle Make & Model *

Engine Size *

Turbocharged or Supercharged No Yes*

Fuel Type Petrol Diesel LPG*

Front Suspension Type Beam Axle Independent*

Rear Suspension Type Beam Axle Independent*

Class Class 1 - Production Class 2 - Modified Production Class 3 - Two Wheel Drive Class 4 - Diesel Engined 4x4 Class 5 - Petrol engine leaf sprung vehicles of any engine capacity Class 6 - Petrol engine vehicles up to and including 2500cc, non-leaf sprung Class 6i - Petrol engine vehicles up to and including 2500cc, Independent suspension Class 7 - Petrol engine vehicles 2501 cc to 3600cc non-leaf sprung Class 7i - Petrol engine vehicles 2501 cc to 3600cc, Independent suspension Class 8 - Petrol engine vehicles over 3600cc non-leaf sprung Class 8i - Petrol engine vehicles over 3600cc, Independent suspension*

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