10th January 2026 – Modified Sedan Entry Form

Car Owner or Team Name *

Drivers Name *

Address *

Suburb *

State *

Phone *

Mobile

Email *

Club

Race Car No *

Please include full prefix in car number.

License No *

Do you need to hire a transponder?

• No
• Yes

Transponder No

Sponsors

Sponsor2

Sponsor3

Sponsor4

Sponsor5

Sponsor6

Prize money to be paid to *

ABN

Account Name *

Bank *

BSB *

Account No *

Submit