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LEICESTER HOMEPAGE

LICENCE APPLICATION

PRE-RACE REGISTRATION

CONTACT

59986740_1220411308123699_57401643702314

LEICESTER

AUTOGRASS CLUB (L)

Homepage

LEICESTER

LICENCE APPLICATION

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

If you have any club queries please contact Matt Duffell
Email Address: autograssleicester@gmail.com
Contact number: 07977937457

NATIONAL AUTOGRASS SPORT ASSOCIATION LTD.

LICENCE APPLICATION FORM

(LEICESTER)

By completing this form you are giving consent to Leicester 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

Email

Mobile number

Street address

Town/City

County

Postcode

LICENCE INFORMATION

Licence Type

Expires 31/01/2022

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

CLUB NUMBER (CAR 2)

Rollcage Tag number (CAR 3)

Choose class for (CAR 3)

Full Car Number including club prefix as it apppears on the car (CAR 3)

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LEICESTER

AUTOGRASS CLUB (L)

Homepage

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LEICESTER

LICENCE APPLICATION

LICENCE APPLICATION FORM

(LEICESTER)

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