SPRINTCAR RACING ASSOCIATION OF VIC. INC.
Reg # A13851X
ABN: 61 203 421 922
PRESIDENT Ian Vale 1 Ovington Place Altona Meadows Vic 3028 PH: Ah (03) 9315 8106 FAX: (03) 8307 8166 SRA Mob: 0417 600 047
NOMINATIONS Lisa Van Der Elst 5 Teresa Court Chelsea Heights Vic 3196 AH (03) 9774 2951 Mob 0433 843 188
E Mail: firstname.lastname@example.org 2007/2008 SRA 360 BRODIX SPRINTCAR SERIES:
NOMINATION FORM DATE:
NAME: ADDRESS: CAR #:
NASR AND / OR SCCA LICENCE #:
(Not accepted without signature of Owner/Driver)
Please tick which round you are nominating for: IF DRIVER IS DIFFERENT TO THE NAME & ADDRESS ABOVE, PLEASE SPECIFY THE DRIVER:
SRA 360 BRODIX Sprintcar Series: (Clearly X the box or boxes of nominated events)
R1 8/12/07 HAMILTON R3 5/4/08 MT GAMBIER R5 26/4/08 (TBA)
R2 5/01/08 SIMPSON (Vic Title) R4 6/04/08 WARRNAMBOOL R6
($100 per round nomination)
TOTAL Amount = $_________
ROUND 1 nominations are to be nominated 30 days prior to the scheduled event. All other rounds the drivers are to nominate 14 days before the scheduled race meeting on the official SRA nomination form (see attachment). Drivers that nominate (30 days for R1 and 14 days for other rounds) prior to a scheduled series round will receive 30 bonus points to the total of that nights events. Nomination cost is $100 Inc GST per car. It is required that you make payment by cheque (made out to “SRA of Vic Inc”) or supply credit card details on the nomination form. You may also pay cash in person (30 days R1 &14 days prior to the other rounds, cash must be given to Lisa Van der Elst, your nomination will not be accepted if cash is given to any other person. Faxed and posted nomination forms, accompanied with payment, must be with Lisa Van Der Elst within the specified time. Postal delays are not accepted as an excuse, please allow five working days for postal service. Phone nominations will be accepted provided full payment details are supplied at the time. On attendance nomination fees received on time will be reimbursed. Late nominations will be accepted, the nomination fee remains at $100.00 Inc GST, but no bonus money or nomination fee will be given to that car. If no nomination is received within 24 hours of the race meeting commencing, then the $100.00 nomination fee can be paid on the day of the race meeting, but the competitor will be starting rear of field in both heats, and will not receive any bonus or nomination reimbursement. Please send your form and payment to Lisa Van Der Elst, 5 Teresa Court Chelsea Heights Vic 3196 or fax or phone with credit card details to Fax # 03 9774 3013 or Phone AH: (03) 9774 2951.
Cheques made payable to S.R.A. of Vic. Inc.
Credit card Number
Card Holders Name Signature _____________________________________
OFFICE USE ONLY PAYMENT RECEIVED (date) ON TIME? CONFIRMATION OF ENTRY SIGNED