Purchase Pit Pass | Victorian Speedway Council

Pit Pass Application

Ambulance Cover/Health Care Card/Private Health Cover*
Ambulance Membership #*
Membership Expiry*
Health Care/Pensioner Card #*
Card Expiry*
Private Health Insurer*
Policy Number*
Policy Expiry*
Proof Of Membership
Accepted file types: jpg, pdf, png, jpeg.
Member of*
PIT PASS REGISTRATION FEE
Price: $ 40.00
Do you want to register car?*
- Yes
- No
NOTE : You can register a maximum of 4 cars for each application. Should you require more please fill out a separate car registration.
1st Car Registration
Class*
Car Type & Model*
Engine Type/Make*
Carburetor (make & size)*
Car Club # (please include clubprefix)*
Day Light #*
Scrutineer*
Upload a pdf or image of your daylight sheet*
Accepted file types: jpg, pdf, jpeg.
CAR REGISTRATION FEE $80
Price: $ 80.00
Do you want to register one more car?*
- Yes
- No
2nd Car Registration
Class*
Car Type & Model*
Engine Type/Make*
Carburetor (make & size)*
Car Club # (please include clubprefix)*
Day Light #*
Scrutineer*
Upload a pdf or image of your daylight sheet*
Accepted file types: jpg, pdf, jpeg.
CAR REGISTRATION FEE $80
Price: $ 80.00
Do you want to register one more car?*
- Yes
- No
3rd Car Registration
Class*
Car Type & Model*
Engine Type/Make*
Carburetor (make & size)*
Car Club # (please include clubprefix)*
Day Light #*
Scrutineer*
Upload a pdf or image of your daylight sheet*
Accepted file types: jpg, pdf, jpeg.
CAR REGISTRATION FEE $80
Price: $ 80.00
Do you want to register one more car?*
- Yes
- No
4th Car Registration
Class*
Car Type & Model*
Engine Type/Make*
Carburetor (make & size)*
Car Club # (please include clubprefix)*
Day Light #*
Scrutineer*
Upload a pdf or image of your daylight sheet*
Accepted file types: jpg, pdf, jpeg.
CAR REGISTRATION FEE $80
Price: $ 80.00
Declaration*
- - I hereby certify that I am a current member of a civil ambulance service/ hold a current healthcare/pension card or have private health insurance which includes Ambulance cover.
- - I agree to be bound by the Rules, Regulations, Specifications, Model Rules and By-laws of VSC.
- - I authorise St. John Ambulance, or other first aid services, to release to VSC details regarding injuries sustained by me at an authorised event.
- - That I am not receiving payment under Workcover, other Compensation schemes or from an accident insurance policy unless clearance to race is provided. If any of the above circumstances changes then you must notify the state office immediately.
- - I agree that the State Office can release my name, address etc. to clubs for the purpose of nominations.
- - I shall accept the decision of the VSC in any dispute under the control of the VSC.
- - That the VSC accepts no liability for the conduct of any non-approved/non-permitted event and will not be liable to any person injured as a result of their participation or attendance at any non-approved event. Any personal accident cover arranged by VSC for and on behalf of drivers/pit crew does not extend to cover any loss or injury suffered at non-approved VSC events.
* I declare that I am medically & physically fit & free from impairment & able to participate in Speedway Activities. I have undertaken or will undertake all necessary medical and/or fitness assessments & examinations required.

* I have read, understood and agree with and acknowledge by submitting this application the VSC Terms and Conditions, Release and Indemnity, Warning and Acknowledgement of Risks, and Dangers; that I assume with full knowledge of the dangers in my participation in speedway activities and do so at my own risk.
- Check here to agree to the above declaration.
Total
$ 0.00
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Pit Pass Application

1st Car Registration

2nd Car Registration

3rd Car Registration

4th Car Registration

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