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Drive for MND registration
carecuresupport
2025-05-28T17:38:54+08:00
Register for Drive for
MND
Register for Drive for MND 2025
"
*
" indicates required fields
REGISTRATION
Captain
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
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Allergies &/or Medical Requirements
Dietary Requirements
Vegetarian
Gluten free
Other (please specify)
Select All
Other Dietary Requirements
CAR DETAILS
Desired Car Number (please note car numbers are based on availability and will be confirmed by the event team)
*
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?
0
1
2
3
4
5
6
7
8
9
10
11
12
Select previous events:
2013 Carnarvon
2014 Esperance
2015 Northam/Nungarin
2016 Busselton/Wellington Forrest
2017 Dongara/Dandaragan
2018 Denmark/Katanning
2019 Margaret River/Bridgetown
2020 The Great Race
2021 Albany/Wave Rock
2022 Avon Adventure
2023 Coastal Crusade
2024 Busso & Beyond
MERCHANDISE
Male T-Shirt Size
Male Small
Male Medium
Male Large
Male X-Large
Male 2X-Large
Male 3X-Large
I've selected a Female T-Shirt
Female T-Shirt Size
Female 8
Female 10
Female 12
Female 14
Female 16
Female 18
I've selected a Male T-Shirt
SPECIAL REQUIREMENTS
Special Requirements
Please list any special requirements or disabled access you may require
REGISTRATION FEE
Individual registration fee (per person) $425
*Includes standard meals (breakfast, morning tea, lunch and dinner), entertainment, entry into event attractions, mystery accomodation on Saturday night and event merchandise including car decals, event t-shirt and cap. All other expenses including participant's car fuel, drinks (both alcoholic and non-alcoholic) and Friday night accommodation in Mandurah 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
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