ARUNGA PARK SPEEDWAY ASSOCIATION INC. MEMBERSHIP FORM

ARUNGA PARK SPEEDWAY ASSOCIATION INC. MEMBERSHIP FORM

2024/2025 SEASON
For any enquiries, please forward them to arungapark@outlook.com

Keep up to date with our racing calendar and any changes throughout the season by visiting our Website or following us on Facebook.

www.arungaparkspeedway.com.au

https://www.facebook.com/ArungaParkSpeedway/
PRIMARY CONTACT DETAILS
FULL NAME

First NameLast Name
MOBILE
Please enter a valid phone number.
EMAIL
example@example.com
POSTAL ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
MEMBERSHIP/S
PLEASE SELECT MEMBERSHIP TYPE/S*

FAMILY MEMBERSHIP @ $150.00 (2x Adults & 2x Juniors)ADULT MEMBERSHIP @ $60.00 (Age 16 years or older)JUNIOR MEMBERSHIP @ $30.00 (Age 15 years or under)LIFE MEMBER @ $0.00 (Person/s awarded Life Membership by APS)VOLUNTEER MEMBER @ $0.00 (Person/s who are volunteering for the duration of the season or hold an Officials Licence)
DETAILS OF MEMBERS
MEMBER #1 - FULL NAME

First NameLast Name
D.O.B
01/01/2024
MOBILE
Please enter a valid phone number.
EMAIL
example@example.com
SELECT RACE CLASS

JUNIOR SEDANS TOP STARSJUNIOR SEDANS NEW STARSSTREET STOCK SEDANSSPRINTCARSWINGLESS SPRINT
CAR #
If applicable
MEMBER #2 - FULL NAME

First NameLast Name
D.O.B
01/01/2024
MOBILE
Please enter a valid phone number.
EMAIL
example@example.com
SELECT RACE CLASS

JUNIOR SEDANS TOP STARSJUNIOR SEDANS NEW STARSSTREET STOCK SEDANSSPRINTCARSWINGLESS SPRINT
CAR #
If applicable
MEMBER #3 - FULL NAME

First NameLast Name
D.O.B
01/01/2024
MOBILE
Please enter a valid phone number.
EMAIL
example@example.com
SELECT RACE CLASS

JUNIOR SEDANS TOP STARSJUNIOR SEDANS NEW STARSSTREET STOCK SEDANSSPRINTCARSWINGLESS SPRINT
CAR #
If applicable
MEMBER #4 - FULL NAME

First NameLast Name
D.O.B
01/01/2024
MOBILE
Please enter a valid phone number.
EMAIL
example@example.com
SELECT RACE CLASS

JUNIOR SEDANS TOP STARSJUNIOR SEDANS NEW STARSSTREET STOCK SEDANSSPRINTCARSWINGLESS SPRINT
CAR #
If applicable
ALL COMPETITORS MUST PROVIDE AMBULANCE COVER OR ADEQUATE PRIVATE HEALTH INSURANCE

ARUNGA PARK SPEEDWAY ASSOCIATION INC WILL NOT BE RESPONSIBLE FOR ANY COSTS INCURRED FOR ROUTINE OR EMERGENCY TRANSPORT TO HOSPITAL
COVER PROVIDER*
MEMBERSHIP #*
NEW MEMBERS

Please complete this section for all new memberships, this is not required for renewal applications. Please list 2 names of current members for reference.
MEMBER PROPOSED BY:

First NameLast Name
MEMBER SECONDED BY:

First NameLast Name
AGREEMENT OF TERMS
DO YOU GIVE AUTHORISATION FOR THE USE OF ANY PHOTOGRAPHS FOR THE LISTED APPLICANT(S) PROVIDED TO THE CLUB FOR ADVERTISEMENT/PROMOTIONAL PURPOSES ON BOTH THE ARUNGA PARK SPEEDWAY WEBSITE & FACEBOOK PAGE?*

YESNO
DO YOU AGREE TO ALLOW ARUNGA PARK SPEEDWAY ASSOCIATION INC TO DISCLOSE ANY OF THE ABOVE DETAILS FOR THE LISTED APPLICANT(S) TO OTHER CLUBS OR ENTITIES FOR PROMOTIONAL PURPOSES?*

YESNO
DO ALL APPLICANT(S) LISTED ON THIS FORM AGREE TO FOLLOW & UPHOLD THE RULES AS LISTED IN THE 'ARUNGA PARK SPEEDWAY ASSOCIATION INC CONSTITUTION 2018' & THE 'ARUNGA PARK SPEEDWAY ASSOCIATION INC CODE OF CONDUCT'*

YESNO
PAYMENT METHOD

PLEASE SELECT THE CORRECT QUANTITIES BEFORE PROCEEDING TO PAYMENT

My Products

FAMILY MEMBERSHIP2x Seniors & 2x Juniors

$150.00AUD Quantity

ADULT MEMBERSHIP16 years or older

$60.00AUD Quantity

JUNIOR MEMBERSHIP15 years or under

$30.00AUD Quantity

LIFE MEMBER MEMBERSHIPFor any person/s awarded Life Membership by APS or updating their details

$ FreeAUD Quantity

VOLUNTEERS MEMBERSHIPFor any person/s who are volunteering for the duration of the season or hold an Officials Licence

$ FreeAUD Quantity

Total

$0.00AUD

Credit Card

Should be Empty:

ARUNGA PARK SPEEDWAY ASSOCIATION INC. MEMBERSHIP FORM

PRIMARY CONTACT DETAILS

MEMBERSHIP/S

DETAILS OF MEMBERS

ALL COMPETITORS MUST PROVIDE AMBULANCE COVER OR ADEQUATE PRIVATE HEALTH INSURANCE

NEW MEMBERS

AGREEMENT OF TERMS

PAYMENT METHOD

Credit Card