14th and 15th July 2007

Please complete to the best of your knowledge in FULL the details below.

Driver

Full Name.............................................................................................................................

Telephone No ..................................................... Fax .................................................

Mobile ............................................................... E-mail................................................

Address .........................................................................................................................

.......................................................................................................................................

.......................................................................................................................................

Co Driver

Name.............................................................................................................................

Telephone No ................................................ Mobile ...............................................

Competition Experience:

Novice. No previous events ………………………………………………………………

Intermediate up to 6 previous events

1. .........................................................................................................................................
2. .........................................................................................................................................
3. .........................................................................................................................................
4. .........................................................................................................................................
5. .........................................................................................................................................
6. .........................................................................................................................................

Vehicle Details

Registration Mark. .........................................

Make ......................................... Model ........................ Colour .........................

Recovery Equipment …………………………………………………………………

…………………………………………………………………………………………..

…………………………………………………………………………………………..

I enclose:

o Non-refundable Entrance Fee £240.00 (Refunds will be made should the organizers not accept an application)

o Completed personal details forms

o Vehicle Registration Document o MOT Certificate o Full Driving Licence

o Car Insurance Policy

I would like to confirm that I wish to compete in the Two 4 Challenge on

14 th and 15th July 2007and have enclosed the £240.00 non-refundable entrance fee.

Full standard terms and conditions for competition are available upon request.

I also confirm that my vehicle will be road worthy (IMPORTANT- A current MOT Certificate will need to be produced to the organizers on arrival to the event in not already sent prior), taxed and have the appropriate insurance for competition whilst competing in the above challenge.

Signed .......................................................................... Date ..................................

Ref: 2006

Impala Adventures

PO Box 7299 , Lutterworth , LE17 4YL

Tel 01455 203167 Mobile : 07930 910870