Off Road Single Event Licence Application

Event Details

Personal Details

Medical Information

Disclaimers & Payment


  • 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.
This applicant is recommended by Club/ Organization/ Individual who is personally known to AASA

 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.
Price: $ 70.00
Transaction Fee: $ 1.56

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