Participant Information

First Name *

Surname *

Cellphone Number: *

E-Mail Address *

ID Number *

Province *

Swift Speed VIP Number 🛈

Shirt Size *

Emergency Contact Details

First Name *

Surname *

Cellphone Number: *

Relationship *

Medical Aid Name & Number *

Vehicle Details

Vehicle Make (eg. Suzuki) *

Model (eg. Swift 1.5 GLS) *

Year Model *

Vehicle Registration *

Drivers License Expiry Date * +

Vehicle Modifications *

Event Details

Event Package *

Swift (28 May only, gift, event entry) - R 500 per entry

Swift RS (Camping, gift, event entry) - R 700 per entry

Swift GLS (single bed chalet, gift, event entry) - R 900 per entry

Which events would you like to compete in? Min 1 - Max 2 *

Track

Swiftkhana

Have you ever driven on a track before? *

Yes

Do you require a driving instructor? *

Yes

* Helmet, long sleeve top and pants are required for track.

Payment Info

BOOKING & PAYMENT NEEDS TO BE IN BY 19 MAY 2017!

Banking details:

Swift Speed

ABSA Savings

Branch: 632005

Acc no: 9258574907

Please use your name and "SS2017" as reference.
Please e-mail Proof of Payment to: info@swiftspeed.co.za only then will your booking be processed.

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