National Race Licence Application

Medical Information Acknowledgement

Application Details

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.

Emergency Contact

Race Information

Medical Information

Have you ever suffered from:

 I agree to refrain from participating in any motor sport events except touring events if I am aware that I am or may be pregnant, and to abide by AASA’s HSE policy regulations.
 I hereby declare I have read the questions above and that the answers I have given are to the best of my belief true, correct and complete in every detail. I further declare that I have not withheld any information or made any statements which are calculated to conceal any reason that could result in the refusal of this licence. I confirm I am aware that if any of the answers given above are affected by any event which might occur during the currency of the licence issued as result of this medical examination I will report such alterations to Australian Auto-Sport Alliance Pty Ltd. forthwith. I undertake not to use any drugs or medication which could have the capacity of affecting my driving ability within 48 hours of my competition and formally agree I will submit to any testing for drugs as may be considered to be justified by any Australian Auto-Sport Alliance Pty Ltd. appointed doctor. I hereby give my full authority to Australian Auto-Sport Alliance Pty Ltd. medical officers to obtain information from relevant clinical records, x-ray and pathology reports from my doctor if required to support this application

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


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

Payment Details

National Race Licence

Price: $ 225.00

Price: $ 50

Price: $ 50

Price: $ 50

Price: $ 225.00
Transaction Fee: $ 4.35

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