Don't miss the event Nominate now ... Nomination form Nomination form Competitor Details: Competitor Name (First & Last) * Competitor Mobile * Competitor Email * Competitor Address * Competitor Address Street Number Street Number Street Name Street Name City City State State Postcode Postcode Emergency Contact Name: * Emergency Contact: * EVENT AND CAR DETAILS: Event Name * Select Event MODIFIED SEDAN DIRT DASH Event Date * Select Date 11 November, 2023 Nominated Division: * Select Division SSA Modified Sedans SSA Production Sedans Street Stock Super Stockers Car Number & Club Prefix: * Speedway Australia Licence Number * Transponder Number (if own) : Your Bank Account details Account Name * BSB number * Account Number Terms and Conditions * I agree to all Terms and Conditions outlined here Submit Nomination
