2021 Doug Chivas Memorial Track Day at Collie Motorplex

This form is for anyone wishing to attend in any capacity at the event. Note, anyone arriving on the day will unfortunately not be able to participate due to new regulations out of our control.

* indicates required fields
First Name *
Last Name *
Email Address *
Phone *
Attendance Type *
Vehicle * (if driving)
Are you a Charger Club of WA member? Yes    No *
Are you a Great Southern Street Machine Club member? Yes    No *
Do you have a second driver? No    Yes (please fill in separate form for second driver) *
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