Modified Production Nominations 7th December 2024

Please enter your nomination in the form below.

Car Owner or Team Name *

Drivers Name *

Address *

Suburb *

State *

Phone *

Mobile

Email *

Club

Race Car No *

License No *

Transponder No

Tranponder Hire

• I need to hire a transponder (AU$30 cash only at the track)
• I need to purcahse a transponder bracket (AU$10)

Chasis No

Engine

Transporter Driver

Sponsors

Sponsor2

Sponsor3

Sponsor4

Sponsor5

Sponsor6

Prize money to be paid to *

ABN

Account Name *

Bank *

BSB *

Account No *

Submit