Race Nomination Form

Race Date *

Membership Category *

Member Member (Family) Junior Member (16 & under) Non-Member Junior Non-Member (16 & under) Prospective (First Time Race)

Driver Name *

First Name Last Name

Email *

How many classes? *

Class 1

Transponder No. 1

7-digits

Class 2

Transponder No. 2

7-digits

Class 3

Transponder No. 3

7-digits

How many junior entries?

Junior Driver 1 Name

Junior 1 Class

Junior 1 Transponder

7-digits

Junior Driver 2 Name

Junior 2 Class

Junior 2 Transponder

7-digits

Junior Driver 3 Name

Junior 3 Class

Junior 3 Transponder

7-digits

Message to us

Fee Rate 1

Fee Rate 2

RACE FEE $

How to Pay *

Online with PayPal Direct Deposit Pay at Track

Fee + Surcharge

Direct Deposit Details

BSB: 014-274

Account: 30-687-1239

Name: Chargers RC

TOTAL RACE FEE

AUD 1.9% transaction fee applies with PayPal

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.