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2022-2023 Club Membership Form
Portland District Motor Sports Club Inc
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* Indicates required question
Email
*
Your email
Name
*
Your answer
Membership Type
*
New Membership
Renew Membership
Required
Street Address, Town, State & Post Code.
*
Your answer
Postal Address (if different form Street Address)
Your answer
Phone Number
*
Your answer
Date of Birth
*
Your answer
Speedway Australia Licence Number
Your answer
Speedway Australia Licence Expiry Date
MM
/
DD
/
YYYY
Are you a member of any other motorsport club.
*
Your answer
Membership Cost
*
$30 - Full Senior Membership
$20 - Full Junior Membership
$15 - Social (Non Driver)
$10 - Pensioner (Age Pension Non Driver)
$10 - Junior (Non Driver 5-13 years old)
$1 - per Race Car Number
Life Membership (Free)
Other:
Required
Race Car Number
Your answer
Under 18 years old Consent
*
ALL DRIVERS UNDER THE AGE OF 18 YEARS MUST HAVE PARENT/GUARDIAN CONSENT BEFORE THEY MAY RACE.
Choose
I Hereby give my consent for my under 18 year old to race.
I do not give my consent for my under 18 year old to race.
N/A
Parent / Guardian Consent Signature
I Hereby give my consent for my under 18 year old to race.
Your answer
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