Racing Driver Booking Form

RACING DRIVERS’ COURSE - APPLICATION FORM - Click here to download

Your booking may be secured by posting/faxing this enrolment form and payment for the full amount - Wakefield Park single day $550.00 inc, GST.

Full payment must accompany application forms and you may pay by cash, cheque or any of the credit cards listed below.

Refunds are not available but you may transfer to another date with one full month’s notice. On receipt we will confirm your booking and send course joining instructions to you.

Please enrol me in the Racing Drivers’ Course: Course Date: ....................

Name: ..........................................................................................

Address: .......................................................................................

......................................................... Post Code ...........................

Phone: (.......).................................. Mobile: ............................  Email ....................

Make of car: ..................................................................................

TAX INVOICE (ABN  74141 869 669)

I enclose cheque/money order for $...........................

I authorise you to debit my account with the following amount $......................

YOUR NAME ON CARD ...........................................................

Card No. __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __  CVN .............

EXPIRY DATE ....../......./....... AMOUNT $................. CARDHOLDER’S SIGNATURE.......................................

TICK CARD: Bankcard‚ Mastercard‚ VISA

To pay by direct bank debit, send monies as detailed below and put the receipt number on enrolment form:

Account Name: FFEA PTY LTD

Bank: ANZ

Branch: Chipping Norton

BSB: 012 087

Account number: 369 097 375

NATIONWIDE DEFENSIVE DRIVING SCHOOL (ABN 74141 869 669)

RTA instructors licence 011609

10 Finschhafen street, Holsworthy NSW 2173

Tel: 0430 777 000 / 1300 900 619 Fax: (02) 9825 1802 e-mail: office@finlays.com.au

OFFICE USE ONLY (Form 18/6/10):

CONFIRMED .............................................................................

PAID ............................................GST : ....................................

COURSE COMPLETED ............................................................

GRADE ......................................................................................

CAMS LECTURE ......................................................................

CAMS LICENCE .......................................................................