2025 CQDRA Membership Application & Renewals

Membership Options *

Individual – $60.00
Family (2 Adults & 3 Children 16yo & under) – $80.00

All amounts include GST

Email *

MEMBER # 1 – Name *

First

Last

Date of birth *

Gender *

Male
Female
Other

Occupation *

Home Address *

Address Line 1

City

State / Province / Region

Postal Code

Postal Address (if different from above)

Phone *

IHRA Licence Number (If Applicable)

Member # 2 Name *

First

Last

Member # 2 Phone *

Member # 2 Email *

Member # 2 Gender *

Male
Female
Other

Member #2 Date of birth *

Member # 2 Occupation *

Member # 2 IHRA Licence Number (If Applicable)

Add Children:

Child # 1 – Name *

First

Last

Child # 1 – Date of birth *

Child # 1 – Gender *

Male
Female
Other

Child # 1 – IHRA Licence Number (If Applicable)

Child # 2 – Name *

First

Last

Child # 2 – Date of birth *

Child # 2 – Gender *

Male
Female
Other

Child # 2 – IHRA Licence Number (If Applicable)

Child # 3 – Name

First

Last

Child # 3 – Date of birth *

Child # 3 – Gender *

Male
Female
Other

Child # 3 – IHRA Licence Number (If Applicable)

Parent or Guardian – please complete this section for person/s under the of 18 years. *

I confirm that I am the parent/guardian of the above named person/s under the age of 18 years. I hereby give my permission for the above named person/s to be members of the Central Queensland Drag Racing Association Inc, and to participate in all suitable activities thereof.

Person completing this form to complete section. *

I confirm that all details provided in this form are true and correct.

By submitting this application you agree to ALL CQDRA – Benaraby Dragway Policies & Regulations *

I agree to ALL CQDRA – Benaraby Dragway Policies & Regulations

All Policies & Regulations can be found by clicking the link below.

Please ensure you regularly familiarise yourself with the Policies & Regulations.

https://thedrags.au/about-us/policies-regulations/

Total

Item Quantity Qty Total

There are no products selected.

Membership Options – Individual 1 $60.00

Membership Options – Family (2 Adults & 3 Children 16yo & under) 1 $80.00

Square surcharge – 2.25% 1 $0.00

Subtotal

Total $0.00

Square *

Card

Name on Card

Square surcharge – 2.25%

Price: $0.00