Bursons Auto Parts Cullen Bullen Raceway- The Home Of Real Country Dirt Track Racing

Name
Email Address
Phone No
Racing Division
Club/Association
Licence/Insurance
Licence Number
Licence Expiry date
Car No & Prefix
Vehicle Make
Sponsor
Race Date
- Sept 22
- Oct 20
- Nov 24
- Jan 19
- Feb 16
- March 30
- April 13
- May 4
By completing this nomination form I acknowledge, understand and agree that it is a condition of my participation in the event that I agree to be bound by, and subject to, the Terms and Conditions of Cullen Bullen Raceway. PDMSC reserves the right to refuse entry and/or exclude any person, without any reason being given
I agree to be bound by the Memorandum of Articles of Association, Rules and Regulations, Constitution of the Club.
Parent/Guardian Consent
Parents/Guardian Signature
By signing the nomination form for this event I understand that the nominated driver and his/her pit crew may appear in visual media (i.e. photographs, video footage) that is undertaken inside the speedway complex and that it remains the property of the media personnel involved. I also agree to any visual media involving the nominated driver and his/her pit crew to be used by the associated media personnel and/or Racing Sedans Australia Inc & Cullen Bullen Raceway.
Send

Thank you for your nomination. If there is any more information we need we will contact you.

Oops. An error occurred.
Click here to try again.

Cullen Bullen Raceway