2006 AUSTRALIAN NATIONAL RALLY OF MERCEDES-BENZ CLUBS

Friday 14th – Monday 17^th April 2006

REGISTRATION FORM – PART 1.

(Please read the Invitation to Register before completing)

R1. Participants’ Details

Surname _______________________________________Given Name_______________________________

Partner’s Surname _______________________________ Given Name______________________________

Children’s names & ages, or other accompanying person’s name____________________________________

________________________________________________________________________________________

Postal Address ________________________________________

                         ________________________________________

                         ________________________________________Post Code_______Country______________

Telephone _________________________________Email _________________________________________

Member of which Mercedes-Benz Club? ______________________________Membership no.? ___________

R2.  Accommodation – please tick as appropriate.

Rydges Residents’ Package – Hotel Room required _____ (details to be shown below)

Double ______ Twin _______    Plus third person in room  _______            Single _____

Accommodation requirements for children (describe) ______________________________________________

________________________________________________________________________________________

Non–Residents’ Package – Hotel room NOT required ________ (The Non-Residents’ Package includes breakfasts on Saturday, Sunday & Monday, with lunches on Saturday & Sunday, but does not include bus transport to & from the evening functions on Saturday & Sunday).

R3. Do any participants in your group have walking difficulties?    Yes/No     If yes, please describe;

Wheelchair _______ Mobility Scooter ________ Quad stick/Walking stick ______

Other Comments; _____________________________________________________________________

R4.  Do any of your party have special dietary requirements?     Yes    No       If Yes, state who and describe;

___________________________________________________________________________________________

R5.  The following Benz, Mercedes or Mercedes-Benz vehicle(s) will be brought to the Rally;

Brand/Model _________________________________ Year _________ Registration Number ________________

(Any comments about the vehicle that may be useful for the display) _______________________________________________________________________________

No vehicles being brought.______________

R6.  Some participants will be without a car, eg. international members. If your car is a 4-door model, are you agreeable to carrying two extra passengers during the two days of touring?   Yes___ No ___   Not applicable ____

R7.  National Rally Costs  –  please circle the Package Cost that applies to you.

Rydges Residents’ Package -- includes accommodation at Rydges Capital Hill.

Couple A$930   Couple with third person in room A$1240      Couple with 2 children A$1030             Single A$680

Non-Residents’ Package

Couple A$490               (single or extras at A$245 per person)

The appropriate fee may be paid in one lump sum by 31st August 2005, or in two equal instalments. The instalments are to be paid by 31st August and 15th November 2005. Indicate by ticking the appropriate box below how you wish to pay.

                        One lump sum _______ instalments _________

Members who make a lump sum payment by 31st August, will go into a draw for a “Mystery Prize”

R8.  Radiator Badge.

Do you wish to purchase a Rally Radiator Badge at A$18 each?   Yes ____How Many? ____            No____

R9.  Method of Payment – Credit Card – signature authorises automatic debit of 2nd instalment on 15th Nov. Cheque or Money Order – made payable to ‘National Rally Account 2006’.

There will be no refunds or cancellations after December 15th 2005, as the Rally must meet its contractual obligations by that date.

When paying by credit card, circle card type, enter number, expiry date, name of card holder, and signature.

Bankcard   Visa   Mastercard   Number ________   ________   ________   ________      Expiry Date ___/___ 

Name of card holder___________________________  Signature of cardholder______________________________

Amount to be debited  1st/full payment $___________       2nd payment (15th November) $ __________

Don’t forget to include radiator badge cost in first payment.           Internet payments not accepted.

Please post or fax this form, with payment as appropriate, as described in the Invitation to Register.

REGISTRATION FORM – PART 2

EXTENDED STAYS IN CANBERRA.

X1.  The venues to be visited as part of the Rally program are listed at para 9 of the Invitation to Register. Listed below are some other national institutions and tourist attractions that could be visited before or after the Rally. This list also shows where entry fees apply and timeframes suggested as being adequate for visits.

X2.  The Mercedes-Benz Club of the ACT offers to arrange visits to these places, and to provide group guides, where numbers warrant. If you wish to avail yourself of this offer, please answer the following questions and complete the table (indicate the venues you wish to visit by ticking in the ‘yes?’ column, and whether you wish to be part of a guided group or visit independently in the ‘Group v Alone” column).

To extend, or not to extend – that is the question!

X3.  Do you wish to extend your stay in Canberra?  Yes/No   If yes, give details below

Surname ________________________________Given Name ______________________________

The full Rally Package covers accommodation for the nights of Friday 14^th, Saturday 15^th, and Sunday 16^th April. Indicate the additional nights that you wish to be booked at Rydges Capital Hill:

Prior ___________________________________________________________

After ___________________________________________________________

(It is your responsibility to pay for the additional nights directly to Rydges Capital Hill Hotel before departure.)