2016/2017 AMCA Car Number ___

AMCA NATIONALSPty / Ltd.Driver AMCA $285This includes GST,.Credit Cards Not Accepted.

Speedway Licence Direct Through Speedway Australia.

12 month subscription commencing on the 1st of July 2016 and ending on the 30th of June, 2017

THIS IS A CONTRACTUALLY BINDING DOCUMENT. IN SIGNING THIS DOCUMENT YOU CERTIFY THAT YOU HAVE READ AND UNDERSTOOD, AND AGREE TO BE BOUND BY, THE CONDITIONS OF BECOMING AFFILIATED WITH AMCA. THESE CONDITIONS ARE SET OUT BELOW. IN SIGNING THIS DOCUMENT, YOU ALSO REPRESENT TO AMCA THAT THE INFORMATION YOU PROVIDE TO US ON THIS FORM IS TRUE AND CORRECT.

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A.M.C.A NATIONALS Pty Ltd. (ABN 89 108 786 027)

P.O Box 275 Blairgowrie, Vic. 3942

Email:

Michael Reidy: 0430540379

Name:______Date of Birth______

Address: ______Postcode______

Postal Address ______Postcode ______

Telephone Number A/H ______B/H ______

Email Address: ______Mobile______

Upon its acceptance of this Application, AMCA will forward your NASR Licence and Insurance Application to NASR, which will allow you to be a contestant in motor racing events nominated by you in the motor car racing season from 1st July, 2016 to 30th June, 2017.

You and the Motor Vehicle nominated for registration are subject to disqualification without notice if, in the sole and unfettered discretion of AMCA, you, your motor vehicle, or crew, pose any threat to safety and/or the orderly conduct of motor racing events or if you are in breach of the AMCA rules.

DECLARATION OF APPLICANT

In this Declaration, a reference to AMCA, a promoter, organizer or sponsor, includes a reference to their respective duly authorized agents, employees, and officials (hereafter referred to as “AMCA Associates”).

In consideration of AMCA’s acceptance of this application, I agree to abide by AMCA’S rules (as amended from time to time) and any further regulations governing an event in which I am competing as a driver.

In addition, I agree as follows:

  1. That neither AMCA nor its Associates warrants, whether expressly or by implication, that any services rendered by them, or on their behalf, will be rendered with due skill and care or that any materials provided in connection with services performed are fit for the purpose for which they are supplied;
  2. To hereby release and forever discharge: AMCA; and any promoter, organizer or sponsor of a motor racing event in which I participate as an AMCA affiliate, from any liability whatsoever arising from my death, or personal injury, (including psychological trauma or nervous shock) or any loss and damage whatsoever and howsoever arising from my participation as a driver or attendance at a motor racing event.

  1. That motor racing is an inherently dangerous activity. By reason of the nature of the motor sports, it is subject to risks of serious personal injury and death which can be caused in circumstances which may or may not be foreseeable. I acknowledge that I may suffer injury or death as a result of:
  • Collision of motor vehicles (or parts of them) with other motor vehicles, persons or fixtures;
  • The unauthorized acts, inadvertence, omission or wilful negligence of scrutineers, officials, other contestants, crew engaged by other participants, or spectators.
  • The inadequacy of facilities (including spectator stands, guard rails, fences) to ensure the safety of persons or property at the event; or
  • Poor track or Pit conditions.
  1. I accept that motor sports are dangerous and that accidents can and do happen and may happen to me. I accept that as a consequence, I may suffer injury or death. I indemnify AMCA and AMCA Associates from and against all liability of any nature whatsoever arising from injuries suffered or wrongful death which may occur, as a result of my participation as a contestant in a motor racing event.
  2. I will abide by the directions given by AMCA officials at any motor racing event at which I am participating as an AMCA Affiliate;
  3. I am over the age of 18 years, or 16 years and accompanied by a guardian.
  4. I am the driver/owner of the above registered AMCA race car and I will be the recipient of payments (prize money and other) as a result of racing in events arranged by AMCA and will be participating in these motor racing activities on the following basis: (Please tick one of the following)
  5. As an Amateur. (ABN not required) AMCA suggest that all competitors/owners seek their own independent Tax Advice in relation to their participation in AMCA events.

Or

  1. As a Business activity. My Australian Business Number (ABN) is: ______

Those claiming GST are required to submit a Tax Invoice for each payment prior to the payment by AMCA.

I fully understand the risks of attending and participating in any motor racing event and accept the above conditions of my registration as an AMCA Affiliate which also govern my participation in motor racing events.

Any false declaration made by an Applicant may result in disqualification from a motor racing event. .

Applicant’s Signature -:

………………………………………………………………………………………Date……/……../……….

Your Bank account Details -: BSB……………………… Acc…………………………..

PRIVACY STATEMENT

The above information is required by AMCA to assess your application to become an AMCA Affiliate which in turn authorizes AMCA to arrange for your entry as a contestant to motor racing events. The above information, and any information which is specific to your health condition, and which you disclose to us, will be used by AMCA for the above purposes and, if you are injured at any motor racing event in which you are participating, your health information may be disclosed to any attending first aid or medical practitioner. By signing this form you consent to the use of your personal information for these additional purposes.

PAYMENT; CASH, CHEQUE, MONEY ORDER OR DIRECT DEPOSIT TO

AMCA NATIONALSBSB 033 624 A/C 145436 (NAME / CAR NUMBER AS REFERENCEALSO SEND EMAIL)

1

A.M.C.A NATIONALS Pty Ltd. (ABN 89 108 786 027)

P.O Box 275 Blairgowrie, Vic. 3942

Email:

Michael Reidy: 0430540379