2023 4WD Adventure Crew Form Step 1 of 4 25% Personal InformationIs your vehicle registered for the 2023 Variety 4WD Adventure?**Please note your car must be registered in the upcoming 4WD before you can complete your crew form. Yes No 4WD Number* Name* Prefix Mr.Mrs.MissMs.Dr.Prof.Rev. First Last Preferred / Nick Name If applicable Is this your first Variety 4WD Adventure?* Yes No How many 4WD Adventures have you done, not including 2023? I know exactly how many I have done I am not sure Number of Variety 4WD Adventures?*Please note this information is used to prepare year awards, if you answer incorrectly you may not receive an award. If you are not sure, click "Not Sure" above and a list of all 4WD Adventures will appear for you to select from. List of all previous 4WD Adventures*Tick all that you have participated in. You can click select all and just un-click some if easier Select All 1997 - Cape York 1998 - Cooks Tour 1999 - The Great South East 1999 - Ford Explorer to Kimberley 2000 - Over the Top 2001 - Surf to Snow, Currumbin to Therdbo 2002 - Brisbane to Birdsville 2003 - Sunset to Sunrise, Cardwell to Karumba 2004 - Land of the Long White Cloud, Christchurch to Christchurch 2006 - Kimberley Explorer, Darwin to Broome 2007 - Cup to Tassie, Melbourne to Tasmania 2008 - Here to Hunter, Brisbane to Hunter Valley 2009 - Big Red to Beyond, Longreach to Tharogmindah 2010 - Head to the Hills, Sydney to Eden 2011 - Kia Ora Aoteraroa, Hamner Springs to Akaroa 2013 - To the Top, Cairns to Cooktown 2014 - Crossing the Kimberely, Darwin to Broome 2016 - Sandy Floors to Cellar Doors, Charleville to Barossa Valley 2017 - Great Southern Land - Tasmania 2019 - Mission Beach to Darwin via Arnhem Land 2022 - Townsville to Port Douglas via The Cape Are you travelling on the 4WD with a family member or partner?* Yes No If yes, please list their name and your relationship* First Name Last Name Relationship Please add the details of any additional relationships belowAre you the Car Captain or a Crew Member?* Car Captain Crew Member Do you know the details of the vehicle you are taking on the 2023 Adventure?* Yes No, not yet What is the vehicle make?* What is the vehicle model?* What is the vehicle year of make?* What is the vehicle registration number?* Please upload a photo of your vehicle or email it to [email protected]Accepted file types: jpg, jpeg, png, gif.Postal Address* Street Address Address Line 2 City State Australian Capital TerritoryNorthern TerritoryNew South WalesQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia Postcode Email* Mobile Phone*Alt PhoneOccupation Do you have a Blue Card?* Yes No Blue Card Number* Blue Card Expiry mm/yy* Shirt Size* Male Female Shirt Size (Men)* S M L XL 2XL 3XL 4XL 5XL Shirt Size (Ladies)* 8 10 12 14 16 18 20 22 24 Medical InformationAll information collected on this form is for use by Variety medical personnel and subsequent medical professionals where required. All information will be held in the strictest of confidence and utilised only in the event of an emergency.Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Do you take any prescription or over the counter medication(s)?* Yes No Please provide medication name, dosage and frequency details for all medication(s)* Do you have, or have a history of any of the following? Please select all that apply.* Anemia Arthritis Asthma Blood Clots Blood Pressure - High Blood Pressure - Low Cancer/Tumors Chest Pain Cholesterol - High Cholesterol - Low Colitis/IBS Diabetes Emphysema Epilepsy/Seizures Gastro Intestinal Ulcers Heart Palpitations Joint Replacement Liver Disease/Disorder Psychological Disorder(s) Stroke I don't have a history of any of these conditions Please provide details on your medical history for the condition(s) selected above:* Do you have any other medical conditions not listed above?* Yes No Please provide details of other Medical Conditions* Emergency Contact & Dietary InformationNext Of Kin Name*Someone not travelling with you who we can contact in case of emergency Emergency Phone Contact*Alt Emergency PhoneDo you have any allergies?* Yes No Allergies* Gluten Dairy Seafood Shellfish Bees Penicillin Other Other Allergies* Do you have any dietary requirements?* Yes No Dietary Requirements*Ie: Vegetarian, Gluten Intolerant Gluten Intolerant Vegetarian Vegan / Plant Based Lactose Free No Red Meat No Seafood Other N/A Please provide details of other dietary requirements* Additional InformationDo you hold a current drivers licence?* Yes No Drivers Licence Number* Drivers Licence Expiry* DD slash MM slash YYYY Issuing State* QLD NSW VIC TAS SA WA NT Participant Declaration* I agree that all critical information provided in this form is true and correct at the time of filling in and I understand it is my responsibility to update Variety Queensland with any changes to the above medical information. By submitting this crew form, I am also agreeing to abide by the Variety 4WD Adventure Code of Conduct and Event Rules and Regulations. CAPTCHA Δ