Nomination Form 2017 - 2018

NOMINATION FORM 2017 - 2018

Please complete the following. All Entrants MUST sign the Nomination Form BEFORE racing. NOM’s MUST be received 7 days prior to each event. Both Drivers name & Owners name MUST be completed.

Please either email your nomination to fax to 03 9338 7476

Drivers Name : ………………………………………………………………………………......

Address : ……………………………………………………………………………………………

……………………………………………………………………………………………..

Car #. : ……………………………… Drivers Email Address : ………………………………………...

Contact Phone # : ………………………. Mobile # : ……………………………………….

Competition Licence #: ……………………………….

Car Owner Name : …………………………………………………………………………………………....

Car Owner’s Mobile # : …………………………… Owners Email Address : ………………………………...

I nominate for the following events. Please tick the appropriate boxes. There is a $70 Nomination fee per round. (please note : RD 6 may have an increased nomination fee)

RD1
4/11/2017 – Timmis Speedway, Mildura VIC / RD2
18/11/2017 – Heartland Raceway, Moama. NSW / RD3
25/11/2017 – Murray Bridge Speedway, Murray Bridge SA
RD4
2/12/2017 - Wangaratta Raceway, Wangaratta VIC / RD5
6/1/2018 – Timmis Speedway, Mildura VIC / RD6
13/1/2018 – All Star Challenge, Simpson Speedway, Simpson VIC
RD7
3/2/2018 – Blue Ribbon Raceway, Horsham. VIC / RD8
10/2/2018 – Heartland Raceway, Moama NSW / RD9
17/2/2018 – Sunline Speedway, Waikerie, SA
RD10
24/2/2018 – Tyson Perez Memorial, Borderline Speedway, Mt Gambier SA / RD11
3/3/2018 - Timmis Speedway, Mildura. VIC / SUNDAY NIGHT
4/3/2018 –Presentation Cabaret
Mildura. VIC
COMPULSORY

I declare that the above racing activities/participation is undertaken on the following basis:

Please tick one of the following As an amateur. (an ABN is not required) As a business activity. ABN number is: ………………….

Prize money will be by DIRECT DEPOSIT. Prize money will be paid to the CAR OWNER

Account Name: ………………………….. BSB : ……………… Account # : ………………………………

DECLARATION : You agree that by signing this document you agree to abide by the Supplementary Regulations used for all events. You certify that you are aware of the risks of attending and participating in any competitive motor racing event and that you have read and understood and agree to be bound by the Promoters conditions of participation.

Drivers Signature: ______

C:\Users\Mandy\Documents\360's\NOM's\2016-17\2016-17 NOM Form.doc