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Personal Information |
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| Name(*) |
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| Surname: (*) |
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| Identity/Passport Number(*) |
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| Contact Numbers(*) |
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| E-Mail(*) |
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| Name & Surname of a Friend/ Family member(*) |
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| Contact Number of Friend / Family Member(*) |
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Vehicle Information |
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| Rental Vehicle |
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| Rental Company: |
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| Booking Reference: |
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| Registration Number ["TBC" for Rental](*) |
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| Make & Model ["TBC" for Rental](*) |
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| Colour ["TBC" for Rental](*) |
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| Transmission:(*) |
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Shiraz [12th - 14th November 2021]
(Early bird pricing, for bookings before 16 October 2020) |
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| 1. Start Day 1 to Finish Day 1 (Hermanus to Race Village on Friday) |
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| 2. Start Day 3 to Finish Day 3 (Race Village to Lourensford Sunday) |
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| 3. Start Day 1 to Finish Day 3 (Hermanus to Lourensford Friday) |
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Conditions |
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| Payment Options Please deposit the correct amount into the Bank Account listed below with Your Surname and booking code as reference. Please send a Payment Confirmation to transfers@hsrotary.co.za Helderberg Sunrise Rotary Club Standard Bank Helderberg: Branch Code 033012 Current Account Number: 072317299 I acknowledge that service fees contributed are entirely non-refundable. Without limitation, if the event, or any part thereof, is cancelled, postponed or otherwise amended, or if any of the amenities, goods or services in relation to the event are no longer provided, whether due to force majeure, safety reasons, failure by service providers to perform, or any other reason or cause, service fees contributed will not be refundable.(*) |
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| Terms & Conditions Vdriver from Helderberg Sunrise Rotary Club designated driverehicle Owners must sign Indemnity Forms Vehicles must be roadworthy and have sufficient fuel for transportation Vehicles must be comprehensively insured and the Insurance Company must be informed that a ( includes any valid licensed driver appointed to drive who may not necessarily be a member of the Helderberg Sunrise Rotary Club) will be driving your car on the 12th - 14th November 2021 HSRC accepts no responsibility for incorrect event/options ticked(*) |
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Indemnity Confirmation |
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| I, the undersigned hereby warrant that my vehicle specified on this form is comprehensively insured with:(*) |
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| I also confirm that I have informed this insurance company that a fully licensed, designated driver of the Helderberg Sunrise Rotary Club designated driver (includes any valid licensed driver appointed to drive who may not necessarily be a member of the Helderberg Sunrise Rotary Club) will be driving on my behalf on the 12th - 14th November 2021(*) |
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| I hereby absolve the Helderberg Sunrise Rotary Club designated driver( includes any valid licensed driver appointed to drive who may not necessarily be a member of the Helderberg Sunrise Rotary Club) and the Helderberg Sunrise Rotary Club and hold them harmless in respect of any damage or claim of whatsoever nature which I, my vehicle or any third party may sustain arising either directly or indirectly from any act or omission by the said designated driver whilst driving my vehicle as set out above.(*) |
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| I hereby confirm that the information above is true and accurate.(*) |
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| Please retype security code:(*) |
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