Motorsport Australia SA Motorkhana Championship Round 1 /Series 3 Atom Sprints Round 1

This entry form is for the Motorsport Australia SA Motorkhana Championship Round 1 and / or Series 3 Atom Sprints Round 1
Driver Information - Relevant for both events

Must be completed by ALL drivers
Drivers Name*
First name & Surname
Date of Birth*

DayMonthYear
Date
Upload you Motorsport Australia Licience and Club Membership below.
Motorsports Australia Licence*

upload current MA licence -
Cancelof
Motorsport Australia licence number & Expiry date*
Mobile Number*
Format: 0000 000 000.
Email*
example@example.com
Emergency Contact
Emergency contact person*
First name & Surname
Emergency contact person Mobile Number*
Format: 0000 000 000.
Drivers Medical Conditions
Drivers Medical Conditions
Does the competitor have any allergies, chronic illness, or medical conditions? If yes , please describe.

MOTORKHANA - Entry Details
Motorkhana Class Entered
Please reference Additional driver 1
All drivers must complete seperate entry forms
Please reference Additional driver 2
All drivers must complete seperate entry forms
Please reference Additional driver 3
All drivers must complete seperate entry forms
Supplementary Regulations Motorkhana
Motorsport Australia Disclaimer

ATOM SPRINTS - Entry Details
Class Entered
Vehicle Type
Please reference Additional driver
All drivers must complete seperate entry forms
Supplementary Regulations and Disclaimer
Supplementary Regulations
Atom Sprints 2026 Series Regulations
Motorsport Australia Disclaimer

ENTRY COSTS FOR EITHER EVENT - ENTRY FEE PER DRIVER

Account Name : Hillclimb SA Incorporated, BSB: 633 000, Account Number: 198 050 031 Refence payment for with your "Surname" so we call allocate funds correctly.
ENTRY COSTS -PLEASE SELECT THE EVENTS YOU WISH TO ENTER*
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MOTORSPORT AUSTRALIA SA MOTORKHANA CHAMPIONSHIP 2026 Round 1 - Junior
Event date 7.3.2026

$30.00AUD Quantity



MOTORSPORT AUSTRALIA SA MOTORKHANA CHAMPIONSHIP 2026 Round 1 - Adult
Event date 7.3.2026

$65.00AUD Quantity



ATOM SPRINTS SERIES 3 ROUND 1 - Junior
Event date 8.3.2026

$70.00AUD Quantity



ATOM SPRINTS SERIES 3 ROUND 2 - Adult
Event date 8.3.2026

$125.00AUD Quantity



I AM AN ADDITIONAL DRIVER AND HAVE BEEN INVOICE ALREADY
$ FreeAUD



Total

$0.00AUD

Parent / Guardian Details

(all juniors aged 12-17 must have a parent of guardian signature and they must be present at all times at the event)
Parent/ Guardian full Name
Parent/ Guardian Contact number
Please enter a valid phone number.Format: 0000 000 000.
Parent/ Guardian's Signature
Drivers Declaration / Signature
YES
Driver's Signature *
PLEASE MAKE SURE YOU COMPLETE THE MOTORSPORT AUSTRALIA SELF SCRUTINEERING FORM

https://motorsport.org.au/wpblob0fe832abcb/wp-content/uploads/docs/default-source/default-document-library/officials/scrutiny/self-scrutiny/motorsport-australia_self-scrutiny-checklist-autotest.pdf?x60444
Should be Empty:

This entry form is for the Motorsport Australia SA Motorkhana Championship Round 1 and / or Series 3 Atom Sprints Round 1