Car No:
Driver Name:                  Nickname:

State of Residence:
Occupation:
Name of Business:
Name of Partner:
Children’s names & ages:
Interests:


Ambition:
Car
Model:
Car                     Class:              Colour:
Car's Racing History:
Past Results:
Team Name:
Team Manager:
Major Sponsor:
Other Sponsors:
Racing Highlights and/or results


Team PR Contact Name:                     Ph:
Email:
I understand that this form, in its entirety, may be passed onto relevant
third parties.
Signature of Driver:               Date:

2007 VEHICLE/PADDOCK/PIT CREW INFORMATION SHEET
Please complete this form
Name ofCompetitor: _______________________________________
Name of Team
Race Transporter Details
Make of Vehicle: ____________________ Registration No: _________________
Length of Vehicle: ___________________ Width of Vehicle: ________________
Length of Awning: ___________________ Width of Awning: ________________
Side of Awning: Left / Right
Type of Vehicle: Truck and trailer / Van / Car and trailer
Support Vehicle Details -subject to room in pits.
Make of Vehicle: ____________________ Registration No: _________________
Type of Vehicle: ____________________ Length of Vehicle: ________________
MARQUEES/GARAGES/:
For payment and information please refer to the Round payment form and entry
details document.
Please tick the relevant box on the payment form and allocate payment for
the amount provided.
These facilities will be organised on your behalf and are compulsory for all
competitors.
TEAM Information
Name of Driver: _______________________________________
Name of Team Manager: _______________________________
Name of Pit Crew 1: ____________________________________
Name of Pit Crew 2: ____________________________________
Name of Pit Crew 3: ____________________________________
Name of Pit Crew 4: ____________________________________
Each entrant will be supplied with 6 passes for each car in the team. (Extra
individual passes may be
purchased from the Promoter of each event).
Please return to: Intermarque
P.O. Box 2069 South Melbourne Victoria 3205
Fax: (03) TBA

2007 PAYMENT AUTHORITY FORM
INTERMARQUE
Please return to:
P.O.Box 2069 South Melbourne Victoria 3205
Ph: 03
Fax: 03
Visa Mastercard Bankcard
CREDIT CARD AUTHORITY – OPTION 1
I would like to pay by credit card for all fees and charges for the Series
and authorise the debit of the
following card:
CARD NUMBER: _ _ _ _ _ _ _ _/_ _ _ _ _ _ _ _/_ _ _ _ _ _ _ _/_ _ _ _ _ _ _ _
EXPIRY DATE: _ _ _/_ _ _
CARDHOLDERS NAME:
SIGNATURE:
CARDHOLDERS ADDRESS:
State: Postcode:
CREDIT CARD AUTHORITY – OPTION 2
I would like to pay the amount of by credit card and authorise the debit
of the following card:
CARD NUMBER: _ _ _ _ _ _ _ _/_ _ _ _ _ _ _ _/_ _ _ _ _ _ _ _/_ _ _ _ _ _ _ _
EXPIRY DATE: _ _ _/_ _ _
CARDHOLDERS NAME:
SIGNATURE:
CARDHOLDERS ADDRESS:
State: Postcode:
Direct Deposits: Intermarque Account Details are:
Bank: Bendigo
Address South Melbourne
BSB No: ??? ???
Account No: >>>????????
Tax Invoices will be issued

Medical Information
Please complete this form in BLOCK CAPITALS
To be completed by EACH Driver
Please complete this questionnaire concerning your medical history.
Information will be treated as confidential and
will only be available to Health professionals - i.e. circuit doctor,
ambulance officers, hospital staff, etc to use in the
event of any injuries or accidents.
Drivers Name: Date of Birth:
Residential Address:
Postcode:
Telephone No: Mobile:
Weight: Height:
Name of Next of Kin: Relationship:
Address:
Postcode:
Telephone No: Mobile:
Name of OWN General Practitioner:
Address of General Practitioner:
Telephone No:
Blood Group (please specify):
(It is advisable to have blood group clearly visible on Driving Suit)
Do you smoke- how many a day?
Do you regularly take any medication prescribed by a doctor? If so, please
list:
Do you routinely take any drugs bought by yourself from a Pharmacy? If so,
please list:
Have you ever taken steroids? (Hydrocortisone/Prednisolone). If so, when and
for how long?
Are you allergic to anything? (e.g. Penicillin/Iodine):
Have you had any operations or been admitted to hospital? If so, please list
dates and reasons:
Have you had any medical conditions or illnesses? (Past or present)
Have you ever had any neck problems or injuries?

Have you ever broken any bones? (Please list)
Have you ever had a general anaesthetic? If so, were there any problems?
Do you have any false teeth, caps or crowns? Please indicate which:
When did you last have a tetanus injection:
Have you had a Hepatitis B vaccination if so when?
This is strongly recommended, as Hepatitis is a blood borne disease
Is there anything you consider relevant or important in your medical history
(e.g. heart/chest problems) if so
please list:
I understand that the above information will be kept confidential and only
released to a Health Professional. I have
provided all relevant and important medical details. I agree to details of
any injuries/treatment received during a race
meeting being released to a Health Professional. I further acknowledge that
the Australian GT Sportscar Group P/L
will not be liable for any treatment I receive and cannot be held liable for
the confidentiality of these records once
handed to Health professionals.
Signature of Driver: Date:
Print Full Name of Driver:
It is essential that this form be returned to the
INTERMARQUE
P.O. Box 2069 South Melbourne Victoria 3205
before you commence racing.