Repco Rally NZ Demo Driver Registration Form

Demo Driver Name *

Demo Driver Contact Phone *

Demo Driver Email *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code

Country

Emergency Contact Name *

Emergency Contact Phone *

Affiliated to *

License Number *

License Grade (MSNZ) *

I have read and acknowledge the event indemnity *

I acknowledge the indemnityPlease read the indemnity at https://www.rallynz.org.nz/2022-repco-rally-nz-driver-indemnity/