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.
APPLICANT DETAILS (INTENDED LICENCE HOLDER)
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)
Photograph of birth certificate if available Upload File
Upload supported file (Max 15MB)
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? I have read, understood and agree to abide by the rules covering Autograss Racing as issued by the National Autograss Sport Association Ltd. (NASA) I further agree to save harmless and keep indemnified the Club, N.A.S.A. and the respective officials, members, landowners, servants, representatives and agents and / or drivers and mechanics from all actions, claims, costs, expenses, and demands in respect of loss, death or injury to myself, howsoever caused, notwithstanding that the same may have contributed to, or occasioned by, the negligence of several persons or bodies otherwise than in connection with the business or activities of the Club or NASA Ltd., and further to keep indemnified the said parties in respect of death, injury, or loss sustained by any third party as a result of the member negligence and / or breach of contract, save in so far as in either event the said liability is covered by a policy of insurance. I further realise that I shall take part in the sport of Autograss Racing entirely at my own risk.
*I accept the above terms & conditions
Tick this box if you require a wallet to be issued with your licence
Please tick this box if you have a medical condition or disability such as epilepsy, are without ar,s/legs/hands, mental or physical incapacity or failure to read a UK registration plate from 25 yards or are colour blind, and supply a suitable doctor's letter confirming that you may safely participate in Autograss Racing.
I have a medical condition as described
Please upload Doctor's letter if required for your condtion (If you are unable to do this you need to contact your club secretary before submitting your application) Upload
Upload supported file (Max 15MB)
Please sign to state you agree to share your information with National Autograss Sport Association Ltd.
*Please tick this box to confirm that you have read and understood the Parental Letter (at the bottom of this application form). Please tick this box to confirm consent for a person between the ages of 10 and 18 years old (minor) to hold any form of NASA licence, and accept the conditions of membership set out that will apply to your child as a member of NASA. If you have not, or do not agree with those terms and conditions, then do not sign this form.
Have you got a different address to the applicant? Submit Application
SUBMITTING YOUR APPLICATION WILL TAKE YOU TO THE PAYMENT SCREEN
(PLEASE DO NOT REFRESH YOUR SCREEN)
