National Gravel Rally Licence Application

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.

For those people who have previously only held a Club level licence must attach a history of at least three (3) events where the Clerk of Course has provided proof of completion of a satisfactory level of competition.

Medical Information

Information given in this statement will be treated in total confidence although the Chief Medical Officer, upon examining this document, is obliged to advise the Organiser of the Event if, at any time, a participant’s medical condition poses an unacceptable risk to that individual or to a co-driver, spectator, race official or any other person attending the Event.

VISION

MOBILITY

MEDICAL

Have you ever suffered from any of the following:

MEDICAL

Please list all medication that you may be taking while attending the event – include prescription, over the counter and health shop preparations.

Medical Declaration

 I certify that this is a true statement of my medical condition. I will advise the CMO of any subsequent medical problems that may arise or any medical treatment that may affect my ability to participate in this event.

General 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.

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
APPLY Coupon
Price: $ 100.00
Transaction Fee: $ 2.10

Credit Card *