Register for the Gippsland 3-Day Tour 2011 online by completing all fields on the form below. Alternatively, you can download the registration form here and mail with your cheque to:

    Alan Beveridge
    8 Sandalwood Court
    Traralgon Victoria 3844

Cheques should be made to Gippsland Delegates Tour Account

Entry fees: $50.00    (Online Payment Details)
Registrations close: 6 June 2011

IMPORTANT:
Registrations will not be accepted unless full payment is received prior to the close date.

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Name:   Address:     City/Town:   State: Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia Postcode:   Phone:   (Please include STD area code) Mobile: Email:     Date of birth:   (dd/mm/yyyy) CA License No:   Club:   Grade: Select from... A Grade B Grade C Grade D Grade   Your grading for the tour may be altered at the discretion of the race director   Please provide additional comment as to your ability:      I have read and agree to abide by the rules of the 3-Day Tour.