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SPEEDWAY AUSTRALIA LICENCE APPLICATION & MEDICAL FORM Please retain a duplicate of this application as a Tax Invoice Licence Enquiries: ([removed] • •
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Document Date: 2013-11-17 22:14:15

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City

Suburb/Town / /

Company

R. Incorporated / Division Lightning Sprints Limited / Mastercard / Legends Light Trucks Limited / AA B B SA / N.A.S. / Division 320 Sprintcars Limited / Sedans A GV Ladies Standard Saloons B Limited / DECLARATION Speedway Australia / Junior Street Sedans Lightning Sprints Limited / GST N.A.S. / B TAS STATE DIVISIONS Bombers Lightning Sprints Limited / Sedans Limited / Midgets A GV Open Sedans A GV Limited / National Association / SPEEDWAY AUSTRALIA / Speedway Australia PO Box 269 Stepney SA / /

Currency

USD / CAD / /

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Facility

Speedway Australia Drug / Sedans Short Course Speedway Utes Stock Cars Super Production Series SPEEDWAY / Hospital Doctor / CAMS MEDICAL INFORMATION Speedway / SPEEDWAY HEALTH STATEMENT / Speedway Australia Licence Applications / Speedway Australia Medical Examination / SPEEDWAY ASSOCIATION/CLUB NAME MUST BE COMPLETED BY ALL APPLICANTS / SPEEDWAY AUSTRALIA LICENCE APPLICATION / Speedway Australia Medical / Speedway Racing Pty Ltd / SPEEDWAY AUSTRALIA Phone / /

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IndustryTerm

Online Licensing System / licence applications / event services / /

Organization

SPEEDWAY ASSOCIATION / Australia PO / National Association of Speedway Racing Pty Ltd / WA STATE DIVISIONS Division / /

Person

JO C JM / /

/

Position

Driver / OFFICIAL / Mechanic / guard / Head Office / Junior Mechanic/Official / club official / Sprinter / medical advisor / /

Product

Midgets RSA Street Stockers Series / /

URL

www.speedwayaustralia.net.au/downloads / www.speedwayaustralia.net.au / /

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