Outback 4x4 Challenge Online Entry Form

As well as completing this form, you will need to print and complete the Credit Card Debit Form and fax it to 03 9723 2022 or send either the Credit Card Debit Form for $500 or a deposit cheque of $500 to:

Outback 4x4 Challenge
PO Box 330,
Croydon Vic 3136

Cheques are to be made payable to P Vanderhorst

* Compulsory Field

Vehicle Class
*Vehicle Class:	Challenge Class Production Class

Driver's Details		Co-driver's Details
*Name:		*Name:
*Address:		*Address:
*Postcode:		*Postcode:
*State:		*State:
*Country:		*Country:
*Ph (Home):		*Ph (Home):
*Ph (Work):		*Ph (Work):
*Ph (Mob):		*Ph (Mob):
*Email:		*Email:
*Age:		*Age:
*D.O.B. (dd/mm/yy):		*D.O.B. (dd/mm/yy):
*Club:		*Club:
Tshirt Size:	M F	Tshirt Size:	M F

Vehicle Information
What 4wd do you plan to enter in this event?
*Make:
*Model:
*Registration:
*Engine and fuel type:	Super Unleaded Diesel
*What winch/es fitted?
*What tyres are fitted?
*What size are they?
*Does the vehicle have a diff lock?	Yes No
What Brand of diff lock?
Front:
Rear:
Is the vehicle fitted with aftermarket suspension?	Yes No
What brand of suspension and what is the lift?

Event information
Have either of you competed in a previous Outback 4x4 Challenge?	Yes No
If the answer is No please supply the name and phone number of two four wheel drive competitors or marshals who can verify your capabilities:
Name 1:
Phone 1:
Name 2:
Phone 2:
What other 4wd challenge or winching events have you been in?

I would like to receive regular updates via email on the Outback 4x4 Challenge and the Alpine 4x4 Challenge events (un-tick the box if you would not like to register for this service). You can unsubscribe from this service at any time and your details will be kept strictly confidential.

After completing all of the fields in this form and submitting it to us we will need to receive a deposit of $500 by either cheque or credit card, before your entry will be considered.

Send a deposit cheque of $500 or a completed Credit Card Debit Form for $500 to:

Outback 4x4 Challenge
PO Box 330,
Croydon Vic 3136

Cheques are to be made payable to P Vanderhorst

Alternatively, the Credit Card Debit Form can be faxed to 03 9723 2022

Applicants will be notified of their acceptance within two weeks of us receiving entries.

To follow up on this entry application please feel free to contact us.

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Outback 4x4 Challenge Online Entry Form

Vehicle Class

Driver's Details

Co-driver's Details

Vehicle Information

Event information