Defender Trophy Participant Information form Please complete this for all participants attending the Defentr Trophy Adventure. This information needs to be 100% accurate for border bookings and reservations. All participants need to complete this form. Order Number Participant Information form (Vehicle & Participant) Driver Information First Name * Last Name * Title * Prof. Dr. Mr. Mrs. Miss. Preferred Name (nickname?): eg Jo de Bruyn (JOJO) Full Name (as on passport) * Occupation Email Address * Passport Nationality * Passport Number * Passport Expiry Date * Rent or Own Vehicle Rent Vehicle Own Vehicle How many people will be attending? * Personal Message or additional information Year of Vehicle Engine of Vehicle e.g. Tdi | Td5 | 2.4 | 2.2 | 2.8 | 3.5 | V8 (Other - please specify) (Leave Blank if unsure or rental) Model of Vehicle e.g. 90/110/130 (Leave Blank if unsure or rental) Tyre Brand e.g. BF Goodrich (Leave Blank if unsure or rental) Tyre Size e.g. 235/85R16 (Leave Blank if unsure or rental) Vehicle Condition (Please ensure that your Landy is in tip top mechanical condition!) Is your vehicle fitted with a winch? Yes No Winch Brand? Winch Size? Is your vehicle fitted with a snorkel? Yes No Own Recovery Gear (Compulsory) Yes No Is your vehicle fitted with recovery points at the front? Yes No Would you like to purchase a 12 ton recovery gear kit for your Defender, R2148,11? | Defender Trophy recovery kit Pull/Snatch | Pull Strap 60mm x 14000kg x 7,5m | Snatch Strap 80mm x 12000kg x 9m | Alloy Bow Shackle 3¼ton | Alloy Bow Shackle 4¾ton | Leather Gloves | Kit Bag Yes No Is your vehicle fitted with recovery points at the rear? Yes No Two way radio with ORRA (Off Road Radio Ass) frequencies? (Compulsory) - Please enquire if in doubts. Yes No Unsure need assisstance Two-way Radio Brand Do you have a GPS with Tracks4Africa maps? Yes No Unsure need assisstance Brand name of GPS? May the organisers and sponsors send you marketing information from time to time? Yes No Do you want a Defender Trophy T-Shirt? Yes No If you selected "yes" what is your shirt size? S M L XL XXL XXXL Co-Driver Information Co-Driver First Name Last Name Title Prof. Dr. Mr. Mrs. Miss. Preferred Name (nickname?): eg Jo de Bruyn (JOJO) Full Name (as on passport) Occupation Email Address Passport Nationality Passport Number Passport Expiry Date Do you want a Defender Trophy T-Shirt? Yes No If you selected "yes" what is your shirt size? S M L XL XXL XXXL Additional Participant Information Additional Participant First Name Last Name Title Prof. Dr. Mr. Mrs. Miss. Preferred Name (nickname?): eg Jo de Bruyn (JOJO) Full Name (as on passport) Occupation Email Address Passport Nationality Passport Number Passport Expiry Date Do you want a Defender Trophy T-Shirt? Yes No If you selected "yes" what is your shirt size? S M L XL XXL XXXL reCAPTCHA *
