SEASON PASS Series 3 Atom Sprints Round 5

Series 3 Atom Sprints - 17th & 18th October

Driver Information : Must be completed by ALL drivers
Drivers Name
First name & Surname
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Email
example@example.com
Mobile Number
Format: 0000 000 000.
Upload you Motorsport Australia Licience and Club Membership below.
Motorsports Australia Licence

upload current MA licence -
Cancelof
Motorsport Australia licence number & Expiry date
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.
Vehicle Information
Vehicle Type
Class Entered
Please reference Additional driver
All drivers must complete seperate entry forms
Supplementary Regulations and Disclaimer
Round - Supplementary Regulations
Atom Sprints 2026 Series Regulations
Motorsport Australia Disclaimer
ENTRY COSTS - ENTRY FEE PER DRIVER

I have a series pass.

I am a series pass holder - no cost

Free

Total

I will be entering the following days - please select for administration purposes.
Drivers Signature

by signing this form you acknowledge that you have read the sup regs and all information supplied is true and correct.
Driver's Signature
Heading
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, must accompany the juniors to Drivers sign in , briefing and scrutineering.)
Parent/ Guardian full Name
Parent/ Guardian Contact number
Please enter a valid phone number.Format: 0000 000 000.
Parent/ Guardian's Signature
Barcode
Should be Empty:

Series 3 Atom Sprints - 17th & 18th October