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to download a Registration Form - Porsche Centre Sydney South

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					                                                       Porsche Centre Sydney South
                                                         Advanced Driver Training

                                      Participants Registration Form - Eastern Creek Raceway

           Total cost for the 1 day course is $895.00 (incl. GST) per participant. PCSS Privilege Card holder is $450.00.
                                            The day includes Track Usage, Tuition and Lunch.

Please enter me in the Porsche Advanced Driving Course:

                                                                  Thursday, 12 August 2010
            Tuesday, 2 March 2010                                                                                  Thursday, 28 October 2010
                                                                     Ladies Day
                 ( Level 1)                                                                                             ( Level 2)
                                                                      ( Level 1)

PARTICIPANTS DETAILS (PLEASE PRINT)

Name:

Address:

Work Tel. No:
                                                                                  Work Fax Number:
Drivers Licence Number:
                                                                                  Email Address:


VEHICLE DETAILS

Porsche Model/Type:
                                                                                  Year:
Registration Number:                                                              Any modifications:

Any Previous Driver Training:
                                             Yes             No                  If yes, where:

PERSONAL DETAILS

Any Special Dietary Requirements:


PARTNER/FRIEND INFORMATION (IF APPLICABLE)

Will your partner attend the Advance Driving Training as an observer:                           Yes              No

(cost $66 per observer per day) If yes, please print name: __________________________________________________________

Please indicate your shirt size to receive your complimentary Porsche Polo Shirt

   Small                   Medium                Large                   X-Large                XX – Large

PAYMENT DETAILS:

Please charge $………….. to my credit card

                                    Visa        Mastercard           American Express              Diners
Credit Card :

Credit Card Number:
                                                                                                                  Expiry Date:

Name on Credit Card:
                                                                                                                  Amount:

Signature:


Please note that places are strictly limited therefore full payment must be received by Porsche Centre Sydney South four (4) weeks prior
to the confirmed date. I understand that my money will not be refunded if I cancel my booking.


Signature: ___________________________________________


                                Please send to: Porsche Centre Sydney South - Attention Hannah Hale
                                  470 Gardeners Road Alexandria NSW 2015 Fax (02) 9317 4911

 Porsche Centre Sydney South respects your privacy, any information provided to Porsche Centre Sydney South will be treated in strict confidence in accordance
                                                           with the Commonwealth Privacy Act 1988.
                                                                     ABN: 76 006 359 459

				
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