Kustom Nationals
ENTRY FORM
Send to: P.O.Box 131 Berwick 3806 Tel 03 9796 2251
Name.............................................… Address.........................................................................………….
Year & Make of Vehicle ............................................................................... Tel…………………….....
Reg.........……..... Type….............………........................... Colour................................
Mods ...........................................................................................…...........................................................
CAR ENTRY FEES:
Weekend Family* Car Entry (2 adults & 2 children under 14)...................... $50.00 $............…
Weekend Driver (Buddy passes $10.00 per day, $20.00 w/end).................... $40.00 $............…
Single Day: Family* ..... $40.00 ........ Driver..... $30.00 specify Sat. or Sunday........ $............…
Yes, I want ............ T\shirts, sizes................…...................................... @ $18.00 ea. $............…
(No Dogs Allowed) Total $________
Zero Alcohol Tolerance on Track... No Alcohol can be brought into the venue!
We agree to release John’s Rod & Custom, Kustoms of Australia, their agents, associates, Phillip Island Grand Prix Circuit,
Bass Coast Shire and everyone connected with the event, from all and any liabilities in regards to damages, injuries, or losses
to ourselves and/or our property, arising in relation with this event.We authorise KOA to use images of ourselves and/or our
cars in promotions, publications, video DVD etc. Vehicle cut off 1976, kustomised cars excepted. Main arena facing the band
stand open to pre-69 body styles and Kustoms only! Attendance of the event confirms acceptance of the above terms.
Signed................................…............................... Date............……..