Club Racing Licence Application

Licence Venue Details

At which venue will you be using this licence for your first event

Personal Details

Your current profile picture

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:
  • 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.

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

Increase weekly benefits to

Price:

 I declare that I have read the Flexible Insurance Options overview and fully understand all aspects of this insurance product
 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.
APPLY Coupon
Price: $ 95.00
Transaction Fee: $ 2.01

Credit Card *