PLEASE NOTE: NO ELECTRIC OR HYBRID VEHICLES ALLOWED

the 2 Vehicle

Date of Event *

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date of birth *

Licence Type *

If you have a valid IHRA Licence, you must use that. Otherwise, please select Drivers Licence.

IHRA Race/Licence Number *

Please enter your IHRA Race/Licence number here.

IHRA Licence Type *

Please enter your IHRA Licence type and expiry date.

IHRA Licence Expiry date *

Please enter your IHRA Licence expiry date

Drivers Licence Number *

Please enter your drivers licence number here.

Will your vehicle be running an Elapsed Time (ET) between 10.00 sec to 12.99 sec 1/4 mile or Motorcycles slower than 9.50 sec 1/4 mile? If unsure, please select Yes. *

Click here to purchase the IHRA Benaraby Dragway event licence:
IHRA Benaraby Dragway event licence

IHRA Day/Event Licence *

Click or drag a file to this area to upload.

I confirm that I have purchased the IHRA Benaraby Dragway event licence and attached to nomination. You will be asked to show your IHRA Event Licence email at the office upon check in.

Vehicle Year *

Vehicle Make *

Vehicle Model *

Engine Type *

Engine Size *

Sponsors (or comments for commentator, limited to 30 characters for tower software)

Will you be bringing a second vehicle? *

No
Yes

Vehicle 2 Year *

Vehicle 2 Make *

Vehicle 2 Model *

Vehicle 2 Engine Type *

Vehicle 2 Engine Size *

Are You a CQDRA Member? *

To become a member and save $$ click here:

Become a member

Nomination Fee (including entry) – Members *

Friday Off Street Meet (CQDRA Member) – $60.00

Nomination Fee (including entry) – Non Members *

Friday Off Street Meet – Non Members – $70.00

Crew Pass Entry – Friday

Price: $10.00

For Friday Only

Under 18 entry – Friday

Price: $1.00

For Friday Only

Will you be bringing a pet to the track? *

No
Yes

If Yes, you agree by the below pet policy.

CQDRA Pet Policy Agreement

Track Regulations *

I agree to the Track Regulations

You can access the Benaraby Dragway Track Regulations here: Benaraby Dragway Track Regulations

IHRA Rules and Regulations *

I agree to all IHRA Rules and Regulations

You can access the IHRA Australia rules and regs using the link below:
IHRA

PARENT/GUARDIAN CONSENT – PERSONS UNDER 18 YEARS OLD

I am the parent/guardian* of the above-named (“the minor”) who is under 18 years old. I have read this document and understand its contents, including the exclusion of liability and assumption of risk, and have explained the contents to the minor. I consent to the minor attending/participation in the event at his/her own risk.

Parent / Guardian Name

First

Last

Next of Kin *

First

Last

Next of Kin contact number *

I confirm that the information provided in this nomination is true, complete, and correct to the best of my knowledge. *

Yes

Total

Item Quantity Qty Total

There are no products selected.

Nomination Fee (including entry) – Members – Friday Off Street Meet (CQDRA Member) 1 $60.00

Nomination Fee (including entry) – Non Members – Friday Off Street Meet – Non Members 1 $70.00

Crew Pass Entry – Friday 0 $0.00

Under 18 entry – Friday 0 $0.00

Square surcharge 1 $0.00

Subtotal

Total $0.00

Payment method *

Credit card via Square – Surcharge applies (2.25%)
Bank transfer

Square surcharge *

Price: $0.00

Square

Card

Name on Card

Payment details for nomination

To secure your race nomination please arrange a bank deposit within 24 hours or pay via card through above field: Westpac Bank BSB: 034 126 Account: 232427 Ref: Surname/bracket

Friday Off Street Drags

PLEASE NOTE: NO ELECTRIC OR HYBRID VEHICLES ALLOWED

Payment details for nomination