top of page
NASA1.JPG

Click here to go back to the National Autograss homepage

60066374_2455162377867369_75337960823046

The Ovals, Lyonshall, Kington, Herefordshire, HR5 3LN

STROUD

 AUTOGRASS CLUB (S-D)

Homepage

STROUD

LICENCE APPLICATION 

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

If you have any club queries please contact Katie Phipps by email Phipps.s12d@blueyonder.co.uk or call 07765 252139

 IMPORTANT MESSAGE FOR STROUD APPLICANTS - PLEASE READ FIRST

Please visit app.stroudautograss.co.uk and complete a membership form for Stroud and District Autograss club prior to applying for your licence here on the Nasa site

NASAC.png

NATIONAL AUTOGRASS SPORT ASSOCIATION LTD.

LICENCE APPLICATION FORM

(STROUD)

By completing this form you are giving consent to Stroud 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)

NASAC.png

LICENCE INFORMATION

arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
Upload File

CAR INFORMATION AND RACE NUMBER

arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v

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.

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.

Upload

Please sign to state you  agree to share your information with National Autograss Sport Association Ltd.