Round Entry

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Your details

SURNAME

GIVEN NAMES

DATE OF BIRTH

LICENSE NUMBER

DRIVERS CLUB

ADDRESS

SUBURB

STATE

POSTCODE

MOBILE PHONE

EMERGENCY CONTACT NAME

EMERGENCY CONTACT NUMBER

Competitor Signature

Driver 1 signature

DATE OF ACCEPTANCE

Car details

COMPETITION NUMBER

LOG BOOK NUMBER

MYLAPS NUMBER

MAKE

MODEL

YEAR

BODY TYPE

COLOUR

CAPACITY

CLASS FOR THIS EVENT

Payment Instructions

Payment Round Fee: $1,495

All Round Fees are to be paid via Bank Transfer to the account listed below with a screen shot of the remittence attached.

Account Details

Account Name: F-RX8 Pty Ltd T/As Formula RX8
BSB: 012505
Account Number: 815031967

UPLOAD CONFIRMATION OF PAYMENT

I have read and accept the Risk Warning & Disclaimer

Fit & Proper Person

I acknowledge and agree that it is a fundamental condition of issue of this licence and its continuing validity that I:

have advised Motorsport Australia in writing of any act, omission, fact or circumstance which may affect my ability to be and remain a fit and proper person to hold this licence and exercise the duties and privileges that relate to it;
have advised Motorsport Australia in writing if I have been found guilty of or charged with any:
- serious indictable criminal offence; or
- sexual offence, (unless this is a ‘spent’ or ‘annulled’¹ conviction); and
undertake to advise Motorsport Australia immediately in writing upon any court of competent jurisdiction making any such finding, or upon being charged with any such offence.

I understand and accept that Motorsport Australia may, in its discretion, if it reasonably believes I am not a fit and proper person to hold this licence or carry out its associated duties, choose to refuse, suspend, or withdraw my licence. However, I acknowledge that I will be given the opportunity to respond in writing to the Motorsport Australia Board before any such decision is made.

¹ As determined by the Crimes Act 1914 (Cth), Criminal Records Act 1991 (NSW), Criminal Law (Rehabilitation of Offenders) Act 1986 (Qld), Spent Convictions Act 2000 (ACT), Criminal Records (Spent Convictions) Act 1992 (NT), Spent Convictions Act 1988 (WA) and/or the Annulled Convictions Act 2003 (Tas) (including their successors and replacements.)

I Understand and Accept the Fit & Proper Person Statement

DECLARATION

ANY APPLICANT MAKING A FALSE DECLARATION IS LIABLE TO REFUSAL AND CANCELLATION OF INSURANCE COVER

I accept the risks arising from or related to attending or participating in Motorsport Australia activities and agree to be bound by and follow all Motorsport Australia regulations, rules and policies. The information I’ve provided is true and accurate, and I will update it with Motorsport Australia if anything changes.

I understand and agree to the terms, including the assumption of risk and indemnity. I have read, understood, acknowledge and agree to the above including the exclusion of statutory guarantees, warning, assumption of risk, release and indemnity.

I understand that false declarations may lead to refusal or cancellation of insurance.

I understand and Accept the Declaration