Australian Vintage Speedway Festival

Lismore Showground

20, 21 & 22 March 2009

NOMINATION FORM

  All completed nominations to be forwarded to: 
Lismore Speedway, PO Box 675, Lismore NSW 2480
,
submitted electronically or faxed to (02) 6621 2733

There is a nomination fee of $60 per vehicle which must be received before your nomination will be accepted. If you have multiple vehicles you must nominate them separately on separate nomination forms.

Lismore Speedway reserves the right to accept or reject any nomination.

Owners Name:    _____________________________________________

Address:
______________________________________________________________

______________________________________________________________


______________________________________________________________

Phone:   ___________________           Mobile:  ___________________            

Email:  ___________________

Vehicle Section: 

___ Super Modified  // ___ Speedcar (uncaged)  //  ____ Speedcar (Caged) //  ____ Solo
___ Super Sedan or Grand National   //  ____ Sidecar  //  ___ TQ  // ___ Other Sedan // ___
Sprintcar

Car Colour: ___________________   Car No. ___________________

If you are a member of a classic or vintage club please nominate your club:  ___________________

ALL DRIVERS must have current NASR insurance that covers them whilst on the track. If required we can supply a one meeting licence for a fee of $30. 
Please note: all second drivers are also required to have NASR insurance.

Drivers Name/s: ___________________, ___________________, ___________________

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Vehicle Details

Make of chassis / frame: ___________________        Originally built by: ___________________ in 19 ____

Body Type / Shape / Style: ___________________  Engine Type: ___________________

Driveline / Rearend: ___________________

Special features:_____________________________________________________________

Past Driver/s: ___________________, ___________________, ___________________

Achievements / Championships / History:
___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Other Information you may wish to share: (details of restoration / when it last raced etc.)
___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Vehicle use at festival: ___ Vehicle will be demonstrating  // ____Vehicle will be on static display only

Payment Options:

  Credit Card Cheque/Money Order Cash

Card Number: _____________________ Card Exp (mm/yy): _____/_____

Name On Card: _____________________________________

Type of Nomination: Midget/Sprint/Car($60) ____ or Solo/Sidecar($30) ____

How many 2 day tickets do you want to order? ($20 / day) _______

Do you need a Day Licence Yes/No (Please note you must choose yes unless you have a NASR card)

**If you pay for your nomination and 2 day passes now you will receive a $10 discount (total $90)

  All completed nominations to be forwarded to: 
Lismore Speedway, PO Box 675, Lismore NSW 2480
,
submitted electronically or faxed to (02) 6621 2733 

 

SCRUTINEERING:  ALL DEMONSTRATING CARS WILL BE REQUIRED FOR SCRUTINEERING ON RACE DAY.

 

SCRUTINEERING:  ALL DEMONSTRATING CARS WILL BE REQUIRED FOR SCRUTINEERING ON RACE DAY.  

Code Of Conduct for demonstrating competitors:

Minimum Safety Apparel