Nominate – Grafton Speedway

Drivers Name

First

Last

Email

Phone Number

Speedway Australia Licence Number

Expiry Date of Speedway Australia Licence

Division Nominating for

Car Number With Prefix

Transponder Number

If no or hired Transponder Number Please put 0

Bank Account Name

The Account for the Prize Money to be Paid

Bank BSB No.

The Account for the Prize Money to be Paid

Bank Account No.

The Account for the Prize Money to be Paid

Sponsors

Make it Looks Nice for the World to see. Capital Letters and use commas after each Business!

Acknowledgment

By Checking this box you understand that competitive motor sporting events, such as the Event, are dangerous and involve a real risk of serious injury or even death from various causes including: motor vehicles (or parts of them) colliding with other motor vehicles, persons or property; acts of violence and other harmful acts (whether intentional or inadvertent) committed by persons attending or participating in the Event.

Nominate for 18th January