Khanacross Entry Form

EVENT DATE: July 26th 2026 VENUE Sapphire Speedway, Tantawangalo Ln, Candelo NSW 2550

ENTRY FEE - Adults $40

Junior 14 yrs+ $20

Payment Method

Direct Deposit

Cash

Direct Deposit into account below (put entrant name(s) in description)

BSB - 641800

Account number - 200755124

Driver 1

Full name

Address

Club

COMPETITION LISENCE NO:

Expiry Date:

Day

Month

Year

Phone:

Email:

Driver 2

Full name:

Address

Club:

COMPETITION LICENCE NO:

Expiry Date:

Day

Month

Year

Phone:

Email:

Driver 3

Full name:

Address

Club:

COMPETITION LICENCE NO:

Expiry Date:

Day

Month

Year

Phone:

Email:

VEHICLE MAKE/MODEL:

CAPACITY Rotary x 1.7 SC or TC x 2):

Colour:

Log Book No:

ENTRANTS DISCLAIMER/DECLARATION:

I/We being the entrant/s of the vehicle described on this entry form wish to enter that vehicle for the above mentioned meeting. I/We declare that the particulars on this form are true and correct in every particular, to the best of my/our knowledge and belief. You are invited to seek legal advice before signing this document.

Signature:

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ENTRANTS AND DRIVER DISCLAIMER AND DECLARATION:

I/We have read and understood the Supplementary Regulations issued for this meeting and agree to be bound by them and by the National Competition Rules of the Australian Auto-Sport Alliance Pty. Ltd. (AASA).

I/We also acknowledge and agree that neither Australian Auto-Sport Alliance Pty. Ltd., nor the sponsor organisations, nor the land owners or lessees, nor the organisers of the event, nor their respective servants, officials, Representatives or agents (all of whom shall be collectively called “the organisers”), shall be under any liability for my death, or any bodily injury, loss or damage which may be sustained or incurred by me, as a result of participation in or being present at the event, except in regard to any rights I may have arising at law.

I/We acknowledge that motorsport is dangerous and accidents causing death, bodily injury, disability and property damage can, and do, happen.

I/WE ACCEPT THE CONDITIONS OF, AND ACKNOWLEDGE THE RISKS ARISING FROM, ATTENDING OR PARTICIPATING IN THE EVENT AND BEING PROVIDED WITH THE EVENT SERVICES BY AASA AND THE ASSOCIATED ENTITIES.

Entrant Signature:

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Date:

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Driver Signature:

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Date:

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Driver 2 / Co-driver Signature:

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Date

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CONSENT FOR ENTRANTS AND COMPETITORS UNDER 18 YEARS

I being the parent/guardian of

Entrants name:

Entrant Signature

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Parent/guardian name

Parent/guardian Signature:

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have read the

whole of this document and consent to him / her participating. In doing so, I acknowledge that Motor Sport is dangerous, and agree that neither Australian Auto-Sport Alliance Pty. Ltd. nor the organisers shall be

under any liability whatsoever for any death or bodily injury, loss or damage which may be sustained or incurred by the above named minor, or by me, howsoever such death or bodily injury, loss or damage is

caused by negligence or otherwise.

Date:

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