CQ Auto Sales CQMSC Khanacross Series

CQMSC Khanacross Rd3 - Proudly supported by CQ Auto Sales

This form replaces the Motorsport Australia Portal and paper-based entry form. Risk Warning, Disclaimer / Indemnity Declaration and Self Scrutiny Statement of Vehicle Compliance forms are still required to be completed by all Entrants.
Have you read the Event Regulations?
Entrant Details
Vehicle Owner

First NameLast Name
Driver

First NameLast Name
Drivers Address

Street Address

Street Address Line 2

CityState

Post Code
Drivers Mobile Phone Number
Please enter a valid phone number.Format: 0000-000-000.
Drivers E-mail
example@example.com
Drivers Emergency Contact

First NameLast NameMobile Number
Please select your License Type (Come and Try or Speed License)
Drivers Motorsport Australia Licence
Number
Expiry

DayMonthYear
2 digit day, 2 digit month, 4 digit yearExpiry Date
Drivers Club Membership

Club NameNumber
Expiry

DayMonthYear
2 digit day, 2 digit month, 4 digit yearExpiry Date
Car Details

MakeModelYearCapacity
Class(s)
Is your Car road Registered?
Registration (Third Party Extension required for the day)

Registrarion NumberExpiry date

Come & Try License + Junior Entry

$100.00 AUD

Come & Try License + Senior Entry

$115.00 AUD

MA Licensed Junior Entry

Junior entry for current MA licensed and club affiliated drivers.

$60.00 AUD

MA Licensed Senior Entry

Senior entry for current MA licensed and club affiliated drivers.

$75.00 AUD

Total

Credit Card

Apple Pay

CQMSC Khanacross Rd3 - Proudly supported by CQ Auto Sales