Open Wheel 30 August 2025

NOMINATION FORM
Open Wheel Meeting: 30th August 2025
(Noms and payment Closing Monday 25th August)
Driver's Name

First NameLast Name
Phone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

SuburbState

Postcode
CAR DETAILS
Car Number
Licence Number
Licence Expiry Date
If you are entering into the Under 18 Sedans and you are UNDER 16 YEARS, a parent/guardian must sign this form below.
Signature
View AASA Waiver by clicking HERE
then tick below.
I AGREE TO THE TERMS AND CONDITIONS OF THE AASA WAIVER FORM.
PAYMENT AND BANKING DETAILS
Payments are to be made by EFTPOS by Midnight on 25 August 2025

Nomination fee: $40

Direct Deposit to:
Account Name: Pioneer Park Motorplex
BSB: 654000
Account Number: 64198782

(Bank:Queensland Country)
Should be Empty:

CAR DETAILS