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BREDON HILL

AUTOGRASS CLUB (B-H)

Homepage

Hilltop Raceway, Hasfield Lane, Tirley, Gloucestershire, GL19 4HA

BREDON HILL

LICENCE APPLICATION

Please follow the process below to apply for a National Autograss Licence and become a member of Bredon Hill Autograss Club. This process if for new and existing membership.

If you have any club queries please contact Carl Burns

email address - BHAutograssClub@hotmail.com

Tel - 07901822229

Website: www.bredonhill-autograssclub.co.uk

or Amanda Mason by email Amanda12@live.co.uk or call 07817 883953

NATIONAL AUTOGRASS SPORT ASSOCIATION LTD.

LICENCE APPLICATION FORM

(BREDON HILL)

By completing this form you are giving consent to Bredon Autograss Club to apply on your behalf for the issue of a NASA licence in the category you select below.

Please complete all details for the applicant (intended licence holders) and tick the "terms and conditions" box . Ensuring that you provide your signature on this application.

In addition, please tick the "medical declaration" ONLY if this applies to you.

APPLICANT DETAILS (INTENDED LICENCE HOLDER)

First Name

Last Name

Mobile number

Street address

Town/City

County

Postcode

LICENCE INFORMATION

Licence Type

Club (Automatically populated)

League (Automatically populated)

Is the applicant (Intended licence holder over the age 18 years old on the 1st February?

Date of birth required for under 18's (Before 1st February)

Age (Before 1st Feb)

Photograph of birth certificate if available

Upload File

CAR INFORMATION AND RACE NUMBER

Have you got an existing car race number?

Have you got a registered vehicle/s with a NASA rollcage tag number?

How many cars registered?

Rollcage Tag number (CAR 1)

CLASS (CAR 1)

Full Car Number including club prefix as it apppears on the car (CAR 1)

Rollcage Tag number (CAR 2)

2 CLASS