ARUNGA PARK SPEEDWAY ASSOCIATION INC. MEMBERSHIP FORM

ARUNGA PARK SPEEDWAY ASSOCIATION INC. MEMBERSHIP FORM

2025/2026 SEASON
For any enquiries, please forward them to committee@arungapark.com.au

Keep up to date with our racing calendar and any changes throughout the season by visiting our Website or following us on Facebook.

www.arungaparkspeedway.com.au

https://www.facebook.com/ArungaParkSpeedway/
PRIMARY CONTACT DETAILS
FULL NAME

First NameLast Name
MOBILE
Please enter a valid phone number.Format: (000) 000-0000.
EMAIL
example@example.com
POSTAL ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
MEMBERSHIP/S
FAMILY MEMBERSHIP @ $150.00 (2x Adults & 2x Juniors)ADULT MEMBERSHIP @ $60.00 (Age 16 years or older)JUNIOR MEMBERSHIP @ $30.00 (Age 15 years or under)LIFE MEMBER @ $0.00 (Person/s awarded Life Membership by APS)VOLUNTEER MEMBER @ $0.00 (Person/s who are volunteering for the duration of the season or hold an Officials Licence)
DETAILS OF MEMBERS
MEMBER #1 - FULL NAME

First NameLast Name
D.O.B
01/01/2024
MOBILE
Please enter a valid phone number.Format: (000) 000-0000.
EMAIL
example@example.com
JUNIOR SEDANS TOP STARSJUNIOR SEDANS NEW STARSSTREET STOCK SEDANSSPRINTCARSWINGLESS SPRINT
CAR #
If applicable
MEMBER #2 - FULL NAME

First NameLast Name
D.O.B
01/01/2024
MOBILE
Please enter a valid phone number.Format: (000) 000-0000.
EMAIL
example@example.com
JUNIOR SEDANS TOP STARSJUNIOR SEDANS NEW STARSSTREET STOCK SEDANSSPRINTCARSWINGLESS SPRINT
CAR #
If applicable
MEMBER #3 - FULL NAME

First NameLast Name
D.O.B
01/01/2024
MOBILE
Please enter a valid phone number.Format: (000) 000-0000.
EMAIL
example@example.com
JUNIOR SEDANS TOP STARSJUNIOR SEDANS NEW STARSSTREET STOCK SEDANSSPRINTCARSWINGLESS SPRINT
CAR #
If applicable
MEMBER #4 - FULL NAME

First NameLast Name
D.O.B
01/01/2024
MOBILE
Please enter a valid phone number.Format: (000) 000-0000.
EMAIL
example@example.com
JUNIOR SEDANS TOP STARSJUNIOR SEDANS NEW STARSSTREET STOCK SEDANSSPRINTCARSWINGLESS SPRINT
CAR #
If applicable
ALL COMPETITORS MUST PROVIDE AMBULANCE COVER OR ADEQUATE PRIVATE HEALTH INSURANCE

ARUNGA PARK SPEEDWAY ASSOCIATION INC WILL NOT BE RESPONSIBLE FOR ANY COSTS INCURRED FOR ROUTINE OR EMERGENCY TRANSPORT TO HOSPITAL
COVER PROVIDER*
MEMBERSHIP #*
NEW MEMBERS

Please complete this section for all new memberships, this is not required for renewal applications. Please list 2 names of current members for reference.
MEMBER PROPOSED BY:

First NameLast Name
MEMBER SECONDED BY:

First NameLast Name
AGREEMENT OF TERMS
YESNO
YESNO
YESNO
PAYMENT METHOD

PLEASE SELECT THE CORRECT QUANTITIES BEFORE PROCEEDING TO PAYMENT

My Products

FAMILY MEMBERSHIP

2x Seniors & 2x Juniors

$150.00AUD Quantity

ADULT MEMBERSHIP

16 years or older

$60.00AUD Quantity

JUNIOR MEMBERSHIP

15 years or under

$30.00AUD Quantity

LIFE MEMBER MEMBERSHIP

For any person/s awarded Life Membership by APS or updating their details

$ FreeAUD Quantity

VOLUNTEERS MEMBERSHIP

For any person/s who are volunteering for the duration of the season or hold an Officials Licence

$ FreeAUD Quantity

Total

$0.00AUD

Credit Card

Should be Empty:

ARUNGA PARK SPEEDWAY ASSOCIATION INC. MEMBERSHIP FORM

PRIMARY CONTACT DETAILS

MEMBERSHIP/S

DETAILS OF MEMBERS

ALL COMPETITORS MUST PROVIDE AMBULANCE COVER OR ADEQUATE PRIVATE HEALTH INSURANCE

NEW MEMBERS

AGREEMENT OF TERMS

PAYMENT METHOD

Credit Card