PE OVAL TRACK RACEWAY

Please Print this form and post to:
P.O. Box 35092
NEWTON PARK
6055
Or hand in at next drivers meeting.

Attach 2 x ID Photos
APPLICATION FOR MEMBERSHIP             SOCIAL MEMBER / FUTURE DRIVER / DRIVER
Surname: ____________________________________Christian Name:______________________________
Address:_________________________________________________________________________________________
TELEPHONE NO: HOME _______________________WORK ______________________CELL _______________________
MALE FEMALE             AGE:____________            MARITAL STATUS___________
CURRENT MOTORSPORT LICENCE HOLDER:
Are you currently a member of a Sports Club? YES/NO
State name of Club:_____________________________________________Contact Person:_______________________________
Have you been a member of an Oval Track Racing Club? YES/NO
If yes, state Club name and dates:__________________________________________________________
Reasons for leaving:_____________________________________________________________________
Contact person (state status)_________________________________________ Tel no:___________________________

(NB: If currently a member a release letter is to accompany this application / NO EXCEPTIONS ON THIS RULE)
Have you any MOTORSPORT or CLUB case/cases pending against you? YES /NO
If yes, state reasons:_______________________________________________________________________________
Who introduced you to the Club?_______________________________
SIGNATURE_____________________ DATE_____________________
NB: STRICTLY - APPLICANTS UNDER 18 YEARS PARENTS/GUARDIAN TO SIGN - CLUB MEMBERSHIP" APPLICATION.
                                 - APPLICANTS UNDER 21 YEARS PARENTS/GUARDIAN TO SIGN -MSA LICENSE DOCUMENTATION IN ORDER TO BE A
                                    COMPETITOR  OR OFFICIAI./MARSHALL NB: AT ALL RACE DAY EVENTS
PARENT/LEGAL GUARDIAN SIGNATURE___________________________

PE Oval Track Committee reserves the right to accept or reject this application without given reasons
OFFICE USE
Date received ____________________Date discussed____________________ Accept I Reject__________________
REASONS________________________________________________________________________
Date given forward to drivers meeting for acceptance ________________________
Drivers' Accept I reject ______________________

CHAIRMAN:____________________ VICE CHAIRMAN____________________

COMMITTEE MEMBER ____________________ COMMITTEE MEMBER ____________________