Mothar Mountain Speedway Gympie Forms

Gympie Speedway | Gympie Saloon Car Club | Mothar Mountain - Queensland's Premier Country Speedway | (07) 5482 4179

Gympie Saloon Car Club

- Old Noosa Rd, Gympie

Race Day Phone

0427 737 174

phone

Gympie's Mothar Mountain Speedway - Gympie Saloon Car Club - 'The Home of Champions'

Mothar Mountain Speedway Forms

Download Forms from this page, print and fax return.

Mothar Mountain Speedway 2011-2012 Nomination Form

(print and fax in to 07 5481 2716)

Mothar Mountain Speedway 2011-2012 Membership Form

(print and fax in to 07 5481 2716)

Mothar Mountain Speedway Change of Details Form

(print and fax in to 07 5481 2716)

or, FILL OUT ONLINE FORM BELOW AND SUBMIT ONLINE

GYMPIE SALOON CAR CLUB LTD

P.O. B O X 2 5 8, G Y M P I E 4 5 7 0

ABN 77 009 882 991

Nomination Form 2011/2012

Nominations close at 12.30 p.m. one week prior to race meeting.

* required field
Nominating for Racing Category:*
Race Date :*
* required field
E-Mail:*
First Name:*
Last Name:*
Address:*
City:*
State:*
Post Code:*
Phone:*
Mobile:*
Member of:*
Make of Car :*
Racing Number :*
Sponsors:*
Q1.Do you declare your racing activities to be a hobby?:*	Yes No
Q2.Do you have an ABN?:*	Yes No
Q3.Are you registered for GST?:*	Yes No
* required field
I, the undersigned DO HEREBY AGREE to indemnify and to keep indemnified the Promoter, Landholder, their agents and officials from all actions, suits, claims and demands for damages or any other expenses whatsoever arising out of, or relating directly or indirectly to or from the use by me on the Gympie Saloon Car Club Ltd, Mothar Mountain Complex and its surrounds for the purpose of/or any purpose connected with practice and/or competitive racing and/or trails and/or motor events. I, further agree that I will promptly carry out any reasonable instructions from any Official of the Gympie Saloon Car Club Ltd and will not in any way, do or suffer to be done, anything contrary to the regulations of the said Club. The Driver shall be responsible for his Pit Crew according to the Racing Rules and Regulations of their Class/Division. All racing is conducted under the ASCF Racing Rule Book. All cars to be below 95 d.b.a. No glass containers are to be bought into the Speedway complex. It is against our Liquor Licence to bring alcohol into the speedway complex. *	Name: I Agree I Disagree Dated:

THE GYMPIE SALOON CAR CLUB RESERVES THE RIGHT TO ACCEPT OR REJECT ANY NOMINATION. NOMINATIONS CLOSE AT 12.30 p.m. ONE WEEK PRIOR TO RACE MEETING.

By signing this nomination 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 this 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 the Gympie Saloon Car Club Ltd.
* required field
If under 18, Parent / Guardian Confirmation must be obtained:*	Parent/Guardian: I Agree I Disagree