Nomination Form

Please include which section each kart number belongs to if applicable. For example: Standard Speedway Kart - NT#24

Please include the kart number each transponder is allocated to. For example (#26 - 185261)

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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.

I Accept that I have read, understood and agree to adhered to the supplementary regulations of this event.

Date for dinner 4th July, 2 Course Dinner Main & Dessert.

Adults $30 Each
Children 5-11 $20 Each
Children Under 5 Free

Number of adults

Number of Children 5-11

Number of Children Under 5

Nomination Fee & Dinner must be paid within the next 3 days via EFT to
BSB: 633 000 Account Number: 160674552 Account Name: DSK Reference: Your name