Drive for MND registrationcarecuresupport2024-06-10T16:18:04+08:00

Register for Drive for MND

Register for Drive for MND 2024 - Busso & Beyond

"*" indicates required fields

REGISTRATION

Captain

Participant (Passenger)

Name*

First Name Last Name

Mobile Number*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Allergies &/or Medical Requirements

Dietary Requirements

Vegetarian

Gluten free

Other (please specify)

Other Dietary Requirements

CAR DETAILS

Desired Car Number*

Car Captain*

First Last

Participants*

List Team Members (each member MUST register separately)

PREVIOUS DRIVE EVENTS

How many previous Drive for MND events have you been on?

Select previous events:

MERCHANDISE

Male T-Shirt Size

Female T-Shirt Size

SPECIAL REQUIREMENTS

Special Requirements

Please list any special requirements or disabled access

REGISTRATION FEE

Individual registration fee (per person) $425

*Includes standard meals, entertainment, entry into the events, mystery accomodation on Saturday night and event t-shirt and cap. All other expenses including fuel, drinks and Friday night accommodation are the responsibility of the individual

PAYMENT (SQUARE)

TOTAL REGISTRATION FEE*

Price:

Total

Credit Card*

Please fill out all fields

Cardholder Name

Card Details

Terms & Conditions*

Yes I accept the terms and conditions

*There may be some delay in processing the payment, please be patient and only submit once to avoid being charged twice

100% of the funds we raise goes towards the care for people living with Motor Neurone Disease (MND), and providing support to the families of people living with MND.

Register for Drive for MND