South West Motorsports Group - Membership Application

Application For Membership

South West Motorsports Group
Applicant Details

Please complete the following fields. * Denotes required fields.
Full Name:*

PrefixFirst NameLast Name
E-mail:*
Would you like to receive member emails regarding events?*

YesNo
Address:*

Postal Address

Postal Address Line 2

SuburbState

Postal Code
Mobile Number:*
Home Number:
Area of Interest:*

Circuit & SprintsBurnoutsDriftingDragsOther
Applicant Type:*

NewRenewal
Member No (if known):
Licence Details
Current Motorsport Australia (MA) Licence Holder:*

YesNo
Motorsport Australia (MA) Licence No:*
Motorsport Australia (MA) Licence Type:*
Motorsport Australia (MA) Licence Expiry:*

MonthDayYear
Date
Current AASA Licence Holder:*

YesNo
AASA Extreme Licence No:*
AASA Licence Type:*
AASA Licence Expiry:*

MonthDayYear
Date
Competition Vehicle(s)

NOTE: All competing vehicles will be scrutineered.
Vehicle 1 Details:
Vehicle 2 Details:
Terms & Conditions

MOTORSPORT IS DANGEROUS. The licence/ticket/credential holder at any event run by South West Motorsports Group (SWMG) is fully aware and recognises that motorsport is inherently dangerous. Entry into and remaining at the race grounds controlled by the committee/promoter has a degree of danger there is a possibility of an accident, causing injury, death, property damage or other losses, and it is a condition of entry that the licence/ticket/credential holder attending these events enters the race grounds and uses the services and facilities on the race grounds ENTIRELY AT HIS/HER OWN RISK. Please Note: By clicking on "I agree" you are accepting these terms & conditions.
Membership Fees (valid from 1 January to 31 December of the current year or any term between)

NOTE: All membership applications will be assessed by the Management Committee and acceptance is not guaranteed.
Once you submit your application, your application will be assessed by the Management Committee at the next Committee Meeting. Acceptance is not guaranteed.

Thank you!

My Products

Club Single Membership$80.00AUD

Club Family Membership$110.00AUD

Total $0.00AUD

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Application For Membership

Applicant Details

Licence Details

Competition Vehicle(s)

Terms & Conditions

Membership Fees (valid from 1 January to 31 December of the current year or any term between)

Credit Card