Registration Open SDMA State Round Entry Form
Today's Date: 18 Mar 2018 - Upon hitting the submit button, this will be recorded as date received.

Southern District Motorsports Association Inc.
Held under the International Sporting Code of the FIA, and the National Competition Rules of CAMS.
PO Box 1484, Queanbeyan, NSW 2620 (Incorporated in the ACT)

CAMS Permit No: 218/1504/03

Event:  NSW HCC Round 3        Date:  Sunday 15th of April 2018        Event Location:  Fairbairn Park
Are you registered for the state Championship?
Declaration by Competitor: I,
Being a Financial member of a CAMS affiliated club and being the owner of the car described below, hereby enter my car for the above event and agree to be bound by the rules thereon which I agree, govern the event.
Drivers Details - It is a CAMS requirement that this section is filled out correctly - you CAN NOT put "as above"




Phone (h)

Phone (w)


Junior Driver

Female Driver

Emergency Contact Name

Emergency Contact Contact Number

CAMS Affiliated Car Club

Club Name:

Club Membership No:
     Expiry Date :      (mm/yy)

CAMS Licence No:
     Expiry Date :      (mm/yy)

Description of Vehicle


Body Type:



Engine Capacity: 

  (E.G: if you have a 1.6l - put 1600...if 2.5l put 2500...if 3.8l put 3800)

Category Type/Class:

( NOTE: If you are a Non Championship car, but do fit into a Championship Type - you can enter into that Type. If you do not fit into any Championship Type, you MUST enter the NLBNRR Type/Classes)

Registered Competition Number:

If not Registered for the Championship, what is you preferred Competition Number:
(NOTE: You are not guaranteed this number - Registered Competitors take preference)

CAMS log Book No: 

Is this car double entered?

If Yes, please add the name of the second driver below (NOTE: This is not the entry for the second driver - it just ensure the two drivers are split in the running order)

Payment Method:     Cost of this hillclimb event is: $120(Senior) and $80(Junior)

EFT Details BSB: 633 000
Account: 153212766
Name: SDMA
Cheque/Money Order/Cash Cheque/Money Order MUST be made payable to SDMA and then forward to: 71 Maitland St, Hackett, ACT 2902
Name: Dave Peisley
Phone: 0409 000 028
By hitting the submit button, you acknowledge all the information entered above is correct. As per CAMS NCR providing false or misleading information will result in your entry being null and void. A confirmation email, together with the CAMS disclaimer will be immediately emailed to you. Please follow the instructions contained within the email.