Round 1 Motorkhana - Bitumen at CQLX
Online Entry Form
14th November 2026
*
I acknowledge that I have read and understood the rules and regulations outlined in the Supplementary Regulations for this event
Competitor (Vehicle Owner)
*
First Name
Last Name
Driver
*
First Name
Last Name
Drivers Address
*
Street Address
Street Address Line 2
City
State
Post Code
Drivers Mobile Phone Number
*
Please enter a valid phone number.
Format: 0000-000-000.
Drivers E-mail
*
example@example.com
Come & Try License
Drivers Motorsport Australia Licence
*
Number
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Expiry Date
Drivers Club Membership
*
Club Name
Number
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Expiry Date
Drivers Emergency Contact
*
First Name
Last Name
Mobile Number
Car Details
*
Make
Model
Year
Capacity
Registered
Unregistered
To reduce work for volunteers, this is a CASHLESS event. Entries can be easily paid for via Square now (preferred) or EFTPOS on the morning. No cash.
Pay now via Square (See below).
Pay on the morning with Square EFTPOS.
Driver Signature
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Pay Easily now via Square if you like!
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Senior Entry
$65.00 AUD
$
65.00
AUD
Junior Entry
$50.00 AUD
$
50.00
AUD
Come & Try License
$40.00 AUD
$
40.00
AUD
Passenger
$5.00 AUD
$
5.00
AUD
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Submit
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