AASA:: ClubKartingLicences

Club Karting Licence Application

Please enter your email address *

Confirm email *

Personal Details

Country *

First Name *

Last Name *

Mobile No. *

Occupation *

Postal Address *

As this information is used for mail merging posted items, please ensure your address is entered with the correct casing. eg. 1 Main Street.

City *

State *

Post Code *

Your current profile picture

This image will be used on your licence.

Would you like to change your image?

YesNo

Profile Picture

Please upload a close up headshot for your licence photo.
Please ensure you upload a normal licence / passport style photo as shown here.
Not a photo of your entire licence.

You must be 6 or older to apply this licence.

Date of Birth *

Country of Birth *

Are you an Australian citizen *

YesNo

Gender *

MaleFemale

Have you previously held a Motor Racing Licence? *

YesNo

If yes, last year held? *

Previous Licence No. *

Issuing Body

Disclaimers & Payment

Declaration:

1/ I certify that the statements made regarding my psychological and physical condition and any previous illness are true and accurate.
2/ I understand that I will not use any drug considered illegal.
3/ I authorize any hospital or medical practitioner to furnish information relevant to my medical condition to a Medical Assessor in order to determine competition fitness

Competency Declaration by Club/ Organization or Individual.

Name of Club/ Organization/ Individual:

Personal Accident Weekly Benefit

The Flexible Insurance Options product overview can be found at the link below.

Please ensure that you have read this document thoroughly before apply for this additional cover.

Click here for Flexible Insurance Options Overview

Would you like to increase your personal accident weekly benefit provided under an AASA permit in the event of a claim? *

YesNo

The standard benefit provided is $900 per week. Please refer to the online insurance summary for additional details. This cover only applies for claims which occur at an AASA sanctioned event.

Please select the amount you would like this increased to: *

$1,100 per week (cost is $500)$1,300 per week (cost is $750)$1,500 per week (cost is $1,000)

Increase weekly benefits to

Price:

Benefit Overview Declaration *

I declare that I have read the Flexible Insurance Options overview and fully understand all aspects of this insurance product

Declaration*

I declare that all information provided for the purposes of this application is true and accurate to the best of my knowledge. I understand that in providing false or misleading information my licence may be suspended or cancelled, and I may not be afforded the coverage of the Personal Accident and Injury insurance provided under the AASA Insurance Scheme. I agree to comply with the AASA National Competition Rules at all times when participating in a AASA Sanctioned Event.

Do you have a coupon?

APPLY Coupon

Yearly Licence Fee

Price: $ 85.00

Transaction Fee: $ 1.83

Total $ 86.83

Credit Card *

Card Number *

Expiration Date *

Security Code *

Cardholder Name *

Club Karting Licence Application

Personal Details

Profile Picture

Please upload a close up headshot for your licence photo. Please ensure you upload a normal licence / passport style photo as shown here. Not a photo of your entire licence.

Medical Information

Disclaimers & Payment

Declaration:

Competency Declaration by Club/ Organization or Individual.

Personal Accident Weekly Benefit

Click here for Flexible Insurance Options Overview

Credit Card *

Please upload a close up headshot for your licence photo.
Please ensure you upload a normal licence / passport style photo as shown here.
Not a photo of your entire licence.