Future Auto Mikes Toughest Officials Reg
Date: 10 February 2018
Street Address, Suburb/Town/City State and Post Code
Mobile Phone No:
Are you a licenced CAMS official?
CAMS licence number and Grade
CAMS licence expiry date?
Date of Birth (If under 18 years)
Medical Details (please indicate any allergies, medications you take, etc. This information remains confidential and will be destroyed post event).
Emergency Contact and Phone Number
Saturday 10 February 2018
Role (Please indicate your preference)
Start of Stage Control Official
Finish of Stage Control Official
SOS / Road Closure (Club Radio Supplied)
Radio Base - Command Centre
If Other - please specify
Other Officials you will be attending with
Type of vehicle you will be attending the event in.
YES - Sedan
YES - 4WD
Other - Ute
NO - travelling with some else
BSCC CLUB RADIO - Please indicate if you have a radio in your vehicle with BSCC Frequencies
Thank your for Registering to be an Official -
Future Auto Presents Mike's Toughest Rally Test Experience
Brisbane Sporting Car Club
The information contained in this form will be compiled by the - Brisbane Sporting Car Club Ltd into a database. No information will be distributed to any third party. By completing this form I give my consent to this information being stored and used by the Brisbane Sporting Car Club Ltd.
Do Not Fill This Out