Cullen Bullen Raceway
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"Action Attraction
Of The Central West
"
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Racing Divisions
Members
Name
Email Address
Phone No
Racing Division
RSA Limited Sedans
RSA Street stockers
RSA 4 Cylinder Sedans
RSA Junior Sedans
RSA Outlaw Sedans
2nd Drivers
Quarter Midgets
Speedway Go Karts
Compact Speedcars
Vintage Speedcars
Vintage Modified
Vintage Sprintcars
Microsprint
Modlites
GP Midgets
Legend Cars
Ligtning Sprints
Formula 500s
Junior Formula 500s
SSA Junior Sedans
SSA Production sedans
SSA 4 Cylinder sedans
SSA Super Sedans
SSA Modified Sedans
SSA Street Stocks
Club/Association
Licence/Insurance
Speedway Australia
Licence Number
Licence Expiry date
Car No & Prefix
Vehicle Make
Sponsor
Race Date
6th Feb 2021
27th Feb 2021
27th Mar 2021
17th Apr 2021
1st May 2021
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
YES
NO
I agree to be bound by the Memorandum of Articles of Association, Rules and Regulations, Constitution of the Club.
Yes
No
Parent/Guardian Consent
Yes
No
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 Cullen Bullen Raceway.
YES
NO
Send
Thank you for your nomination. If there is any more information we need we will contact you.
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