Modern Race Nomination Form

Race Date*

Membership Category*

Driver Name*

First NameLast 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 Entry 1 Name

Junior Entry 1 Class

Junior Entry 1 Transponder

7-digits

Junior Entry 2 Name

Junior Entry 2 Class

Junior Entry 2 Transponder

7-digits

Junior Entry 3 Name

Junior Entry 3 Class

Junior Entry 3 Transponder

7-digits

Message to us

Fee Rate 1

Fee Rate 2

RACE FEE $

How to Pay*

Online with PayPalDirect DepositPay at Track

Fee + Surcharge

Direct Deposit Details

BSB: 014-274

Account: 30-687-1239

Name: Chargers RC

TOTAL RACE FEE

AUD1.9% transaction fee applies with PayPal

Payment Methods

Debit or Credit Card

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

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