2021 NSWPWC ONLINE Entry Form

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* AJSBA Code of Conduct (PDF)
* AJSBA Membership, Licensing, Application & Indemnity (PDF)

2021 NSWPWC Club Round *

NSWPWC Endurance Only (JAN 10 - Homestead Park, Chipping Norton Lakes)

IF YOU OR ANYONE IN YOUR CLOSE CIRCLE have any flu/cold like symptoms at any time in the lead up to this event please DO NOT turn up on the day. This event will operate under strict Social Distancing rules. It is incumbent on Competitors, Club Members and Guests to adhere to the rules set down with our Covid Safe Plan that will be distributed to Competitors/Members at or prior to the event and highlighted at the Riders briefing. Competitors/Members are required at all times to take direction from our nominated Distancing Safety Officer or NSWPWC Committee member.

COVID-19 : Do you currently have COVID-19 or in the last 7 days have you been tested for COVID-19 and awaiting results? *

Name *

Email *

DoB *

Address *

Suburb *

State *

Postcode *

Mobile # *

Government PWC Licence # *

Government PWC Licence Expiry *

State the Licence was issued in? *

AJSBA Annual Race Licence # (if applicable) *

If you hold a current AJSBA Race Licence please enter your Licence Number. Note: the annual licence cost is $250 for the first family member, $200 for the second family member and $150 for the third family member. For first-time competitors, a $50 day licence is available and should you decide to compete at the next NSWPWC event the $50 will be deducted from the $250 annual licence fee. To secure your AJSBA licence contact the AJSBA Secretary at secretary@ajsba.org.au or go to www.ajsba.org.au. To complete this application enter the word 'Pending' in place of the Licence Number.

AJSBA Annual Race Licence Expiry (if applicable)

If you hold a current AJSBA Race Licence please enter your Licence Expiry date.

Emergency Contact *

Emergency Contact Relation *

Emergency Contact Phone # *

Full Name (Helper) *

Please nominate your 1 helper for the day

PWC Registration #

Race Number

If you have a race number please enter it here.

Rookie Runabout Practice ($50)

Enduro Runabout MOTO 1 ($100)

Please select your entry in Moto 1 or Moto 2 NOT BOTH

Enduro Runabout MOTO 2 ($100)

Please select your entry in Moto 1 or Moto 2 NOT BOTH

Second Class ($50)

Message

If you have any question/issue relating to your entry to this race please include here

Indemnity *

YES - I have read and understood, the AJSBA declaration and indemnity associated with Racing.

Code of Conduct *

YES - I have read and understood the AJSBA Code of Conduct

Total Fees *

Please add up the total fees owing. Payment details will be on the confirmation email. Please pay promptly and remember to include your NAME as a reference.

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