Junior Classic
Name
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First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Speedway Australia #
*
Kart Number
*
Class
*
Midgets
Sub Junior
Junior
Junior Standard
Standard Lite
Standard Heavy
Modified
125cc NGB
Transponder Number / Class
If you have Personal Transponder. Please enter here with the class you entered.
Transponder Number / Class
If you have Personal Transponder. Please enter here with the class you entered.
Hire Transponder
Hire
Indemnification INDEMNITY CLAUSE I, the person stated above DO HEREBY AGREE to indemnify and keep the Promoter, Landholder, their Agents and Officials from all actions, suits, claims and demands for damages or any other expenses what so ever arising out of, or relating to or from the use by me on the Maryborough Sporting Car Club circuit and it’s surrounds for the purpose connected with practice and / or competitive racing or trials and or motor events. I further agree that I will promptly carry out any reasonable instructions from any Official of the Maryborough Sporting Car Club and will not in any way, do or suffer to be done, anything contrary to the regulations of the said club. The DRIVER shall be responsible for his or her Pit Crew according to the racing rules and regulations. I also understand that the nominated driver and his/her pit crew may appear in visual media (i.e. photographs, video footage) that is taken inside this speedway complex and that it remains the property of the media personnel involved; I also agree to any visual media involving the nominated driver and his/her pit crew to be used by the associated media personnel and/or Maryborough Sporting Car Club.The promoter/club has the right to refuse any nomination.Indemnification *By checking this box you accept the following indemnification: This entry will be accepted only on the condition that the vehicle entered, the owner, the driver therefore any other person connected with the said vehicle whilst participating in the above mentioned contest do so at their own risk. The entrant, driver or any person connected with the vehicle entered shall have no claim against any of the organisers or the people acting on behalf of the organisers or promoters for any loss, damage or injury to them in the said contest or surrounds. I acknowledge and understand and will abide with the Speedway Australia racing rules and those set out in this nomination form and its attachments.
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I Accept
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Submit
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