Cars Online Entries "*" indicates required fields Step 1 of 9 - EVENT 11% Please select an event and championship typeEVENT*--- PLEASE SELECT AN EVENT ---Klerksdorp 200 (5 October 2024)Carletonville 200 (2 November 2024)Hartbeesfontein 150 (7 December 2024)CHAMPIONSHIP TYPE*--- PLEASE SELECT CHAMPIONSHIP TYPE ---ClubRegionalClub + RegionalNationalWarrior Class (3 Laps)Warrior Class (4 Laps) Driver License DetailsDRIVER NAME* DRIVER SURNAME* DRIVER DATE OF BIRTH* DRIVER ID NUMBER DRIVER WOMZA LICENSE NUMBER LICENSE STATUS CLUB NAME DRIVER ADDRESS Street Address Address Line 2 Town / City Province Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country DRIVER TELEPHONE* DRIVER TELEPHONE (WORK) DRIVER FAX NO. DRIVER EMAIL* DRIVER - MEDICAL AID/INSURANCE DETAILS FOR HOSPITAL ADMISSION PURPOSESI hereby agree to be attended to by doctor/paramedics if I am injured and wish to be transported to the type of hospital indicated* PRIVATE HOSPITAL STATE HOSPITAL MEDICAL AID SCHEME NAME TYPE OF SCHEME MEMBERSHIP NUMBER PRINCIPAL MEMBER PERSONAL (HOME) DOCTOR DOCTOR CONTACT NUMBER MEDICAL CONDITIONS BLOOD GROUP / ALLERGIES HAVE YOU SUSTAINED RECENT INJURY/ILLNESS?--- PLEASE SELECT ---YESNOIF YES, HAVE YOU BEEN CLEARED AS MEDICALLY FIT?--- PLEASE SELECT ---YESNOEMERGENCY PERSONS NAME & CONTACT NUMBER RELATIONSHIP Navigator License DetailsNAVIGATOR NAME NAVIGATOR SURNAME NAVIGATOR DATE OF BIRTH NAVIGATOR ID NUMBER NAVIGATOR WOMZA LICENSE NUMBER NAVIGATOR LICENSE STATUS CLUB NAME NAVIGATOR ADDRESS Street Address Address Line 2 Town / City Province Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country NAVIGATOR TELEPHONE NAVIGATOR TELEPHONE (WORK) NAVIGATOR FAX NO. NAVIGATOR EMAIL NAVIGATOR - MEDICAL AID/INSURANCE DETAILS FOR HOSPITAL ADMISSION PURPOSESI hereby agree to be attended to by doctor/paramedics if I am injured and wish to be transported to the type of hospital indicated PRIVATE HOSPITAL STATE HOSPITAL MEDICAL AID SCHEME NAME TYPE OF SCHEME MEMBERSHIP NUMBER PRINCIPAL MEMBER PERSONAL (HOME) DOCTOR DOCTOR CONTACT NUMBER MEDICAL CONDITIONS BLOOD GROUP / ALLERGIES HAVE YOU SUSTAINED RECENT INJURY/ILLNESS?--- PLEASE SELECT ---YESNOIF YES, HAVE YOU BEEN CLEARED AS MEDICALLY FIT?--- PLEASE SELECT ---YESNOEMERGENCY PERSONS NAME & CONTACT NUMBER RELATIONSHIP VEHICLE DETAILSVEHICLE MAKE YEAR MODEL ENGINE MAKE ENGINE CAPACITY NO. OF CYLINDERS REGISTRATION NUMBER CLASS DETAILSPLEASE CHOOSE WHICH CLASS YOU ARE ENTERINGSPECIAL VEHICLES--- PLEASE SELECT CLASS ---APBCPRODUCTION VEHICLES--- PLEASE SELECT CLASS ---SPDEFG SxsideCOMPETITION NUMBERRACE NUMBER VEHICLE SCRUTINEERINGCompetitor Number Visible Front & Both Sides?* Yes No Fuel Tank Lines?* Yes No Race-Wear 1 Pce Suit & Helmets and Gloves?* Yes No Battery Fitment & Clamps* Yes No Roll Cage?* Yes No Seatbelts 4 Point Harness?* Yes No Kill Switch?* Yes No Fire Walls?* Yes No Seat Fitment?* Yes No Radiator - All?* Yes No Mirrors?* Yes No Body Panels?* Yes No Tyres?* Yes No Selfstarter?* Yes No Fluid Leaks?* Yes No Wheel Nuts?* Yes No Recovery Points?* Yes No Bumpers?* Yes No Lights-Rear Yellow? (min x1)* Yes No Lights-Brakes Red? (min x1)* Yes No Lights-Front White? (min x1)* Yes No Lights-ORL Green? (min x1)* Yes No Fire Extinguisher? (min 2kg)* Yes No Medical Kit?* Yes No Life Hammer & Knife?* Yes No Water? (min 2lt)* Yes No Medical Board Cross, OK Board?* Yes No Hooter?* Yes No CONSENT I AM OVER 21 AND ACCEPT THAT ALL INFORMATION IS CORRECT I AM THE PARENT/GUARDIAN OF THIS UNDER 21 YEAR OLD AND ACCEPT THAT ALL INFORMATION IS CORRECT PARENT / GUARDIAN NAME PARENT / GUARDIAN CONTACT NUMBER
