Council of Heritage Motor Clubs NSW IncAnnual CHMC Rally 8-9-10-11-12th April 2021

In conjunction with Temora Antique Motor ClubEntry forms available on council’s website –

www.temora.nsw.gov.auEntry Form

Closing Date 31st January 2021 – or at 100 entriesEnquiries: Rally Director – Les Buckley – 0417296865 email: auskitcar1@iprimus.com.au

Entrants Name: …………………………………………………… Passenger 1: ……………………………….

Passenger 2: ………………………………………………………… Passenger 3: ………………………………..

Address: …………………………………………………………………………………………………………………………………

…………………………………………………………………………….. P/code: ……….. Phone: …………...

Email: …………………………………………………………………. Mobile: ………......

Club: …………………………………………………………………..

Vehicle Make: ………………………………….. Model: ……………………….

Year: …………. Body Style: ………………….Do you intend to enter this vehicle in the Concourse? Yes/NoPLEASE NOTE THAT ALL CLUBS WILL BE AUTOMATICALLY ENTERED IN THE MAL MASON SHIELDRALLY REQUIREMENTS

Venue NumberRALLY ENTRY $75.00Saturday night BBQ Dinner get together -

hosted by T.A.M.C.Temora Greyhound

Club**

Sunday Night Presentation Dinner Ex-Services Club $30pp “ “ “ “ Kids meals $15Monday Morning Breakfast Lake Centenary ** No Charge

TOTAL $ ** Numbers for Catering only. No charge for these items.

Please indicate any special dietary requirements ……………………………………………………Sunday – Catering services available on site – complimentary morning & afternoon teas each day

CERTIFICATIONI am a member of the above mentioned Club and the vehicle entered is eligible as required by the CHMC.Signed …………………………………………………. Printed Name ………………………………………………. Date ……………………

Or post toT.A.M.C.

P O Box 348TEMORA NSW 2666

Cheques to be made

payable to TAMC

NoteReceipts will be placed in entrant’s Rally Bag. If an early receipt is required, please include

a stamped self-addressed envelope.

Please email entry form to above email address.

Direct debit details: Temora Antique Motor ClubBSB:802-367 Acc. No: 100013988It is VERY important you put your name & club in description field