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
PLEASE SELECT MEMBERSHIP TYPE/S
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
SELECT RACE CLASS
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
SELECT RACE CLASS
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
SELECT RACE CLASS
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
SELECT RACE CLASS
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
DO YOU GIVE AUTHORISATION FOR THE USE OF ANY PHOTOGRAPHS FOR THE LISTED APPLICANT(S) PROVIDED TO THE CLUB FOR ADVERTISEMENT/PROMOTIONAL PURPOSES ON BOTH THE ARUNGA PARK SPEEDWAY WEBSITE & FACEBOOK PAGE?
DO YOU AGREE TO ALLOW ARUNGA PARK SPEEDWAY ASSOCIATION INC TO DISCLOSE ANY OF THE ABOVE DETAILS FOR THE LISTED APPLICANT(S) TO OTHER CLUBS OR ENTITIES FOR PROMOTIONAL PURPOSES?
DO ALL APPLICANT(S) LISTED ON THIS FORM AGREE TO FOLLOW & UPHOLD THE RULES AS LISTED IN THE 'ARUNGA PARK SPEEDWAY ASSOCIATION INC CONSTITUTION 2018' & THE 'ARUNGA PARK SPEEDWAY ASSOCIATION INC CODE OF CONDUCT'
PAYMENT METHOD

PLEASE SELECT THE CORRECT QUANTITIES BEFORE PROCEEDING TO PAYMENT

My Products

FAMILY MEMBERSHIP

2x Seniors & 2x Juniors

$150.00 AUD Quantity

ADULT MEMBERSHIP

16 years or older

$60.00 AUD Quantity

JUNIOR MEMBERSHIP

15 years or under

$30.00 AUD Quantity

LIFE MEMBER MEMBERSHIP

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

Free Quantity

VOLUNTEERS MEMBERSHIP

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

Free Quantity

Total

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

My Products

Credit Card