Motorsport Licensing & Event Insurance - Officials Licence Application

Personal Details

First Name*

Last Name*

Mobile*

Date of Birth*

Age*

IMPORTANT: AASA Officials Licence applications for 14-17 year old’s cannot be submitted online.
Please complete the application form found here and submit it directly to the AASA office.

Are you based in Australia or New Zealand?*

Australia
New Zealand

Address (Postal Address)*

As this information is used for mail merging posted items, please ensure your address is entered with the correct casing. eg. 1 Main Street.

Address (Address Line 2)

Suburb*

State*

Postcode*

Email*

Country*

In case of emergency please supply information for your Emergency Contact.

First Name*

Last Name*

Mobile*

Email*

Address (Street Address)*

Please ensure your address is entered with the correct casing. eg. 1 Main Street.

Address (Address Line 2)

City*

State*

Postcode

Country*

Working With Children Check

Working with Children Check*

WWCC Number:*

WWCC Expiry Date:*

Please provide supporting documentation for your Working With Children Check:*

Declaration - WWCC*

I declare that I am in the process of applying for my Working with Children Check and will provide these details to AASA once received. I understand that from 1st August 2017 it is a requirement that, as a AASA Official, I must provide confirmation of a valid Working with Children's Check.

Official Information

Please include details of your officiating - discipline/s and role/s.

Official Duty*

Have you previously held an Officials Licence?*

Yes
No

If yes, which Licence Category (Please tick all appropriate)*

Please supply details of your officialling history. Please attach a list of other relevant motorsport experience

Event

Area Worked In

Date

Event

Area Worked In

Date

Event

Area Worked In

Date

Event

Area Worked In

Date

Photo Upload

Please upload an appropriate profile image to be used on your officials licence hard card.*

The photo must be submitted in passport orientation, clearly showing head and shoulders. We would appreciate if the photo was high resolution and taken in good lighting. Try to avoid using a photo with an overly dark background or wearing dark sunglasses.

References

Please provide the contact details of two senior officials who could provide appropriate referencing to AASA staff if necessary.

Reference 1

Recommended By*

Officiating Role/s*

Mobile*

Email*

Reference 2

Recommended By*

Officiating Role/s*

Mobile*

Email*

Disclaimer

Declaration:
Exclusion of liability, release and assumption of risk.

I agree to be bound by the rules of the event and provisions of the National Competition Rules of the Australian Auto-Sport Alliance Pty. Ltd.

In exchange for being able to attend or participate in the event (including acting as an event official), I agree:

• to release Australian Auto-Sport Alliance Pty. Ltd. (AASA), promoters, sponsor organisations, land owners and lessees, organisers of the event, their respective servants, officials, representatives and agents from all liability for my death, personal injury, psychological trauma, loss or damage (including property damage) howsoever arising from my participation in or attendance at the event, except to the extent prohibited by law;
• that AASA and the Associated Entities do not make any warranty, implied or express, that the event services will be provided with due care and skill or that any materials provided in connection with the services will be fit for the purpose for which they are supplied; and
• to attend or participate in the event at my own risk.

I acknowledge that:
• the risks associated with attending or participating in the event include the risk that I may suffer as a result of:
• motor vehicles (or parts of them) colliding with other motor vehicles, persons or property;
• acts of violence and other harmful acts (whether intentional or inadvertent) committed by persons attending or participating in the event; and
• the failure or unsuitability of facilities (including grand-stands, fences and guard rails) to ensure the safety of persons or property at the event.
• motor sport is dangerous and that accidents can and do happen and may happen to me.

I also acknowledge and agree that I have been fully instructed in my duties and am familiar with the activities associated with being an official. I understand that this disclaimer is not intended to exclude any valid claim by an official under the AASA Personal Accident Insurance Scheme. I will at all times remain behind the protective barrier provided unless directed otherwise by my senior officials, or if my specific duties require it, and then only for the minimum time required to carry out those duties.

I declare that I am medically and physically fit and free from impairment and able to carry out normal duties expected of the position I will hold at the Event.

I am willing to submit myself to the controls and restrictions applied to all officials at the Event.

I accept the conditions of, and acknowledge the risks arising from, attending or participating in the event and being provided with the event services by AASA and the Associated Entities.

Disclaimer Acknowledgement*

I AGREE THAT I HAVE READ AND UNDERSTOOD THE ABOVE STATEMENT

Privacy Statement: Australian Auto-Sport Alliance Pty. Ltd. requires the information requested herein to assess your application. Please tick the box if you do not wish to receive any sponsors or other third party information or promotional materials.

I do NOT wish to receive information.