THE WILLY WAGTAIL RALLY
HOSTED BY THE CHITTERING BRANCH OF THE VCCC AND THE AUSTIN MOTOR VEHICLE CLUB
Friday 19th Sept. to Monday 22nd Sept 2025
Entries to be sent to: Jeff and Alvera Gibbs, no later than the 1st of August 2025
Email address: froggyville34@bigpond.com Mobile 0488 118 492
ALL PAYMENTS TO AUSTIN MOTOR VEHICLE CLUB OF WA
BENDIGO BANK BSB 633 000 ACCOUNT 207 335 084
PLEASE PRINT DETAILS IN BLOCK LETTERS.
Driver …………………………………………………. Phone No. ………………………….
Address…………………………………………………………………………........................
Email Address ………………………………………………………………………………….
Navigator ……………………………………………… No of passengers ………………….
Year and make of Vehicle ……………………………………………………………………...
Vehicle Registration Number ………………………………………………………………….
Class (Please circle) Veteran Vintage Post Vintage Modern
REGISTRATION DETAILS Total
Entry fee (per vehicle) $15.00 $ 15.00
Friday 19th Sept 2025
4.30 pm Meet & Greet at the Bowling
Club Maroubra Ave Bullsbrook $15.00 per person $..............
Saturday 20th September
Morning Tea to be advised
Lunch at Limestone Park Café and Aviary
Fergusson Drive Beermullah At your own expense
Saturday evening meal (meat, salads and desserts)
Mad hat event. Prize for the best mad hat
Held by the Bullsbrook Bowling Club $25.00 per person $...............
Sunday 21st September 2025
Bindoon Historic Day Food vans and stalls on site or At your own expense
Visit the Bindoon Bakery
Sunday evening meal Chequers Hotel Bullsbrook
Pay for your own meal. Need numbers attending for booking …………………
Monday breakfast at 34 North Ave Bullsbrook $10.00 per person $................
TOTAL ==========
Dietary requirements (Please specify if special meals are required )
…………………………………………………………………………………………….
ASSUMPTION OF RISK AND DECLARATION OF INDEMNITY
I understand that my participation in this rally event may expose me, my property, my reserve driver & passengers, if any, to risk of death, personal injury, loss or damage, which risks may or may not be foreseeable, & I hereby voluntarily assume all such risks as a condition of my application to participate. I have read the Constitution & the Rally Rules of the Veteran Car Club of WA Inc or the Austin Motor Vehicle Club of WA Inc. In consideration for my being allowed to participate in this rally event, I hereby agree to be bound by the said Constitution & Rally Rules, & I further agree to have harmless & keep indemnified the rally event organizers, promoters & all club members, along with their respective officials, servants, agents & representatives, from & against all actions, claims, costs, expenses & demands of any kind, in respect of death, personal injury, loss or damage to me, my property, my reserve driver or passengers, however caused, that arise or are alleged to arise out of or in connection with my entry or participation in the rally event, except insofar as such actions, claims, costs expenses & demands are covered by an Insurance Policy with the State Government Insurance Commission or such other insurance company. I understand all monies shall be refunded should my application be denied.
I declare that my vehicle is currently licensed & roadworthy & that I hold the appropriate driver’s licence.
Signed…………………………………… Date: ……………………………….
