CQ Mudsportz Twin Track Vehicle Nominations

CQ Mudsportz Twin Track Vehicle Registration - 19th September 2026
Date

YearMonthDay
4 digit year, 2 digit month, 2 digit dayDate
Attendee Information

Please fill name and contact information of attendees.
Your Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Post Code
Contact Number
Please enter a valid phone number.Format: 0400 000 000.
Email Address
example@example.com
Driver Name

First NameLast Name
Vehicle Details
Class
Which Events are you competing in? (More than one can be chosen)
A late fee is payable due to being outside of the cut off date. Please select it below:
Junior Drivers must be 10yrs of age no older than 16 years of age and have entry form signed by Parent or Guardian.

NOTE: ALL DRIVERS AND CREW MUST BE A MEMBER OF A MUDRACING CLUB THAT CURRENTLY HOLD TWIN TRACK EVENTS AND HAVE OWN PERSONAL INJURY INSURANCE COVER WITH AASA INSURANCE.

ON THE DAY MAKE SURE YOUR MEMBERSHIP & INSURANCE CARD IS CURRENT.

YOU MUST ALSO HAVE A CURRENT LOG BOOK.

❌ NO MEMBERSHIP NUMBER / NO INSURANCE --> NO RACING ❌

YOU MUST AGREE TO THE TERMS AND CONDITIONS (AVAILABLE VIA THE LINK BELOW) OR THE FORM WILL NOT BE ACCEPTED.
Conditions of Entry
Drive Indemnity
Driver's Signature - By signing, you agree to the terms & conditions.
Upload Proof Of Insurance (If not able to do so, it must be sighted at the Canteen prior to racing).

Cancelof
Co-Driver Indemnity
Crew Member Indemnity
If the driver of any Motor Vehicle is under age of 18 years, the consent of the Parent or legal Guardian MUST be obtained as a counter signature of this release and indemnity. Consent to the use of the Raceway/Track mentioned herein and agree to be bound by this release indemnity. I acknowledge that the Co-Driver for any Junior Driver must be over 21 years of age.

Parent/Guardian Name

Membership Number

Insurance NumberDate

Postal / Zip Code
Upload Proof Of Age (eg: Birth Certificate etc)

Cancelof
Parent/Guardian Signature
Total Amount for Entry:
Processing Fees (2.2% of purchase amount)
Nomination Total incl Fee:
ALL FEES MUST BE PAID BEFORE ENTRY CLOSURE DATE. NO PAYMENTS ON RACE DAY.

Payment Amount

AUDTotal Amount of Entry

Payment Methods

Credit Card

Apple Pay

Should be Empty:

CQ Mudsportz Twin Track Vehicle Registration - 19th September 2026

Attendee Information

Conditions of Entry

Payment Amount

Payment Methods