Darwin Speedway Riders & Drivers Association Inc.

PO Box 392, BERRIMAH NT 0828

Telephone: (08) 8984 3469

Facsimile: (08) 8984 3469

Email: racing@darwinspeedway.com.au

Website: www.darwinspeedway.com.au

Receipt No : …………

DSRDA RACE NOMINATION

MEETING DATE: …………………………………………..

COMPETITOR’S NAME: ……….…………………………………………..

COMPETITOR’S RACE NUMBER ………………………

SECTION: Sprintcars q AMCAs q Saloons q Junior Sedans q

GoKarts q 350 Sprintcars

Other (Give details) ……………………… q

FEE PAID: Early Nomination $ 50.00

Late Nomination $ 75.00

SECRETARY/TREASURER: ……………………………..…… DATE: ….