DayLicences

Day Licence Application

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New Applicants

Please enter your email address *

Confirm email *

Personal Details

Country *

First Name *

Last Name *

Mobile No. *

Occupation *

Postal Address *

As this information is used for mail merging posted items, please ensure your address is entered with the correct casing. eg. 1 Main Street.

City *

State *

Post Code *

You must be 14 or older to apply this licence.

Date of Birth *

Are you an Australian citizen *

YesNo

Gender *

MaleFemale

Please select your event type *

CircuitOff RoadKartingRallysprint / RallycrossDriftBurnoutSpeedwayDrag Event

Please select your licence type*

Club Level Driver / NavigatorState Level Navigator

You must be 14 or older to apply this licence.

Event Name *

Event Duration *

Single DayMulti Day (Max 2 days)

Single Day Event Date *

Multi Day Event End Date *

Have you previously held a Motor Racing Licence? *

YesNo

If yes, last year held? *

Previous Licence No. *

Issuing Body

Medical Information

Blood group *

Tetanus Immunisation Date

Allergies?

YesNo

Please list *

Have you ever been diagnosed as having and/or had treatment for: (Please tick)

1. A psychiatric or psychological illness? *

YesNo

2. Persistent or severe headache, head injury, epilepsy, seizure or loss of consciousness? *

YesNo

3. Heart or lung disease, including infection, blood vessel disease, hypertension, coronary bypass, angioplasty or other surgical procedure? *

YesNo

4. Cancer, diabetes, kidney, liver, thyroid, gastrointestinal, blood pressure disorders, including any associated surgical procedures? *

YesNo

5. Any other significant illness, injury or surgery not already noted? *

YesNo

6. Have you taken any medications, including self-medication or alternative therapies? *

YesNo

7. Do you have any hearing impairment or loss? *

YesNo

8. Do you suffer from any hearing disorder including tinnitus? *

YesNo

9. Is your eyesight normal in both eyes for distance vision? *

YesNo

If NO do you wear spectacles or contact lens? *

YesNo

10. When did you last have a medical examination? *

Please give full details if you answered YES to any of the above questions: *

Disclaimers & Payment

Declaration:

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.
4/ I acknowledge that motorsport is dangerous and agree that AASA shall not be under any liability whatsoever for any death or bodily injury, loss or damage which I may incur, howsoever such death or bodily injury, loss or damage is caused, by negligence or otherwise.

For Female Applicants: 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.

Competency Declaration by Club/ Organization or Individual.
This applicant is recommended by Club/ Organization/ Individual who is personally known to AASA

Name of Club/ Organization/ Individual:

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.

Refund Policy

Please click here to read the AASA Refund Policy

I accept I/We have read the Refund Policy

Do you have a coupon?

APPLY Coupon

Yearly Licence Fee

Price: $ 40.00

Transaction Fee: $ 1.02

Total $ 41.02

Credit Card *

Card Number *

Expiration Date *

Security Code *

Cardholder Name *