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WESSEX

AUTOGRASS CLUB (WS)

Homepage

Bearley Raceway, Bearley Lane, Tintinhull, Yeovil, Somerset, BA22 8PE

WESSEX HOMEPAGE

LICENCE APPLICATION

PRE-RACE REGISTRATION

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CONTACT

WESSEX

LICENCE APPLICATION

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

If you have any club queries please contact Lisa Hills at wessexautograss@gmail.com or call 07909 737992

NEW INFORMATION ABOUT LICENCES -

In The Southern League we offer an adult non-working/racing licence, which is priced higher than a standard adult licence. A non-working licence holder is not expected to help out on track work days/race days. Before purchasing one of these licences you must first apply via email to secretary@southernautograss.co.uk, detailing the reason why you want one. There are a limited number available, so your application is not guaranteed to be accepted.

Also, we offer an Intermediate Junior licence. Any Juniors holding this licence aren't expected to attend track work days but are required to help out on race days.

NATIONAL AUTOGRASS SPORT ASSOCIATION LTD.

LICENCE APPLICATION FORM

(WESSEX)

By completing this form you are giving consent to Wessex 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

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

Photograph of birth certificate if available

Upload File

CAR INFORMATION AND RACE NUMBER

Rollcage Tag number (CAR 1)

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

Rollcage Tag number (CAR 2)

CLUB NUMBER (CAR 2)

Rollcage Tag number (CAR 3)

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

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

IMPORTANT - Please tell us about your medical conditions

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

Applicant's Signature

*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.

Parent/Guardian Signature

Parent/Guardian Full Name

Parent/Guardian Email

Legal relationship to applicant

Street address

Town/City

County

Postcode

SUBMITTING YOUR APPLICATION WILL TAKE YOU TO THE PAYMENT SCREEN

(PLEASE DO NOT REFRESH YOUR SCREEN)

PARENT GUARDIAN DECLARATION.

Only the child's parent may sign this form, or such person who has been appointed by the court as guardian or foster parent of the child.

Please read the terms of this consent carefully, if you do not understand anything then ask your local Club Secretary for clarification. It is designed to create a legal relationship between you and ourselves and, by signing the document where required, you confirm that you have read this document and agree to abide by its terms and conditions and requirements.

Autograss Racing is a sport that minors may participate in with their parents' consent. It is not organised primarily for minors but their involvement is encouraged providing they and their parents understand the hazards that are associated with the sport. Motor racing is dangerous and may involve the risk of injury or death.

Click here to go back to the National Autograss homepage

WESSEX

AUTOGRASS CLUB (WS)

Homepage

Bearley Raceway, Bearley Lane, Tintinhull, Yeovil, Somerset, BA22 8PE

CURRENTLY UNAVAILABLE​

WESSEX

LICENCE APPLICATION

LICENCE APPLICATION FORM

(WESSEX)

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CURRENTLY UNAVAILABLE