NOMINATION FORM
Can be used to nominate up to six drivers and up to four classes per driver
EVENT
EVENT DATE
/
Day
/
Month
Year
Contact person
*
First and Last name
Email
*
example@example.com
Contact number
*
How many drivers?
*
1
2
3
4
5
6
How many drivers are you nominating?
Payment Method
*
PayPal
Pay at the track
There is a discount for paying by PayPal
Submit
Driver 1
Driver 1
*
First and Last name
Club 1
*
Adelaide
Alice Springs
Angas
Blanchetown
Busselton
Desert Dirt
Dirt Trackers
Great Southern
Jennacubbine
Loxton
Lucindale
Meekatharra
Morgan
Port Pirie
Renmark
Tatiara
Top End
Weipa
Yorke Peninsular
The club that this driver is a member of
AIDKA Licence Number 1
*
Enter 0 (zero) for a SINGLE EVENT LICENCE
Classes 1
*
1
2
3
4
How many classes is this driver is nominating for?
Collapse Stopper
Class 1 (Driver 1)
Class 1-1
*
Midgets
Rookie
Jnr Light
Jnr Heavy
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 1: Class 1
Kart 1-1
*
Kart number
Entry 1-1
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Class 2 (Driver 1)
Class 1-2
*
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 1: Class 2
Kart 1-2
*
Kart number
Entry 1-2
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Class 3 (Driver 1)
Class 1-3
*
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 1: Class 3
Kart 1-3
*
Kart number
Entry 1-3
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Class 4 (Driver 1)
Class 1-4
*
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 1: Class 4
Kart 1-4
*
Kart number
Entry 1-4
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Driver 2
Driver 2
*
First and Last name
Club 2
*
Adelaide
Alice Springs
Angas
Blanchetown
Busselton
Desert Dirt
Dirt Trackers
Great Southern
Jennacubbine
Loxton
Lucindale
Meekatharra
Morgan
Port Pirie
Renmark
Tatiara
Top End
Weipa
Yorke Peninsular
The club that this driver is a member of
AIDKA Licence Number 2
*
Enter 0 (zero) for a SINGLE EVENT LICENCE
Classes 2
*
1
2
3
4
How many classes is this driver is nominating for?
Collapse Stopper
Class 1 (Driver 2)
Class 2-1
*
Midgets
Rookie
Jnr Light
Jnr Heavy
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 2: Class 1
Kart 2-1
*
Kart number
Entry 2-1
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Class 2 (Driver 2)
Class 2-2
*
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 2: Class 2
Kart 2-2
*
Kart number
Entry 2-2
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Class 3 (Driver 2)
Class 2-3
*
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 2: Class 3
Kart 2-3
*
Kart number
Entry 2-3
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Class 4 (Driver 2)
Class 2-4
*
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 1: Class 4
Kart 2-4
*
Kart number
Entry 2-4
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Driver 3
Driver 3
*
First and Last name
Club 3
*
Adelaide
Alice Springs
Angas
Blanchetown
Busselton
Desert Dirt
Dirt Trackers
Great Southern
Jennacubbine
Loxton
Lucindale
Meekatharra
Morgan
Port Pirie
Renmark
Tatiara
Top End
Weipa
Yorke Peninsular
The club that this driver is a member of
AIDKA Licence Number 3
*
Enter 0 (zero) for a SINGLE EVENT LICENCE
Classes 3
*
1
2
3
4
How many classes is this driver is nominating for?
Collapse Stopper
Class 1 (Driver 3)
Class 3-1
*
Midgets
Rookie
Jnr Light
Jnr Heavy
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 3: Class 1
Kart 3-1
*
Kart number
Entry 3-1
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Class 2 (Driver 3)
Class 3-2
*
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 3: Class 2
Kart 3-2
*
Kart number
Entry 3-2
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Class 3 (Driver 3)
Class 3-3
*
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 3: Class 3
Kart 3-3
*
Kart number
Entry 3-3
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Class 4 (Driver 3)
Class 3-4
*
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 3: Class 4
Kart 3-4
*
Kart number
Entry 3-4
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Driver 4
Driver 4
*
First and Last name
Club 4
*
Adelaide
Alice Springs
Angas
Blanchetown
Busselton
Desert Dirt
Dirt Trackers
Great Southern
Jennacubbine
Loxton
Lucindale
Meekatharra
Morgan
Port Pirie
Renmark
Tatiara
Top End
Weipa
Yorke Peninsular
The club that this driver is a member of
AIDKA Licence Number 4
*
Enter 0 (zero) for a SINGLE EVENT LICENCE
Classes 4
*
1
2
3
4
How many classes is this driver is nominating for?
Collapse Stopper
Class 1 (Driver 4)
Class 4-1
*
Midgets
Rookie
Jnr Light
Jnr Heavy
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 4: Class 1
Kart 4-1
*
Kart number
Entry 4-1
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Class 2 (Driver 4)
Class 4-2
*
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 4: Class 2
Kart 4-2
*
Kart number
Entry 4-2
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Class 3 (Driver 4)
Class 4-3
*
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 4: Class 3
Kart 4-3
*
Kart number
Entry 4-3
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Class 4 (Driver 4)
Class 4-4
*
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 4: Class 4
Kart 4-4
*
Kart number
Entry 4-4
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Driver 5
Driver 5
*
First and Last name
Club 5
*
Adelaide
Alice Springs
Angas
Blanchetown
Busselton
Desert Dirt
Dirt Trackers
Great Southern
Jennacubbine
Loxton
Lucindale
Meekatharra
Morgan
Port Pirie
Renmark
Tatiara
Top End
Weipa
Yorke Peninsular
The club that this driver is a member of
AIDKA Licence Number 5
*
Enter 0 (zero) for a SINGLE EVENT LICENCE
Classes 5
*
1
2
3
4
How many classes is this driver is nominating for?
Collapse Stopper
Class 1 (Driver 5)
Class 5-1
*
Midgets
Rookie
Jnr Light
Jnr Heavy
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 5: Class 1
Kart 5-1
*
Kart number
Entry 5-1
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Class 2 (Driver 5)
Class 5-2
*
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 5: Class 2
Kart 5-2
*
Kart number
Entry 5-2
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Class 3 (Driver 5)
Class 5-3
*
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 5: Class 3
Kart 5-3
*
Kart number
Entry 5-3
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Class 4 (Driver 5)
Class 5-4
*
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 5: Class 4
Kart 5-4
*
Kart number
Entry 5-4
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Driver 6
Driver 6
*
First and Last name
Club 6
*
Adelaide
Alice Springs
Angas
Blanchetown
Busselton
Desert Dirt
Dirt Trackers
Great Southern
Jennacubbine
Loxton
Lucindale
Meekatharra
Morgan
Port Pirie
Renmark
Tatiara
Top End
Weipa
Yorke Peninsular
The club that this driver is a member of
AIDKA Licence Number 6
*
Enter 0 (zero) for a SINGLE EVENT LICENCE
Classes 6
*
1
2
3
4
How many classes is this driver is nominating for?
Collapse Stopper
Class 1 (Driver 6)
Class 6-1
*
Midgets
Rookie
Jnr Light
Jnr Heavy
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 6: Class 1
Kart 6-1
*
Kart number
Entry 6-1
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Class 2 (Driver 6)
Class 6-2
*
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 6: Class 2
Kart 6-2
*
Kart number
Entry 6-2
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Class 3 (Driver 6)
Class 6-3
*
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 6: Class 3
Kart 6-3
*
Kart number
Entry 6-3
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Class 4 (Driver 6)
Class 6-4
*
KT Light
KT Medium
KT Heavy
KT Twin
Statesman
125 Light
125 Heavy
100 Open
200 Open
Outlaw
Driver 6: Class 4
Kart 6-4
*
Kart number
Entry 6-4
*
Normal
Rear of Field
Probationary
Single Event Licence
Entry Type
Collapse Stopper
Should be Empty: