4×4 MAYHEM – Benaraby Dragway

Date of Event *

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

City

State / Province / Region

Postal Code

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Date of Birth *

Licence Type *

IHRA Licence number: *

Please enter your IHRA Licence number here

IHRA Licence type: *

Please enter your IHRA licence type here

IHRA Licence Expiry date *

Please enter your IHRA licence expiry date here

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? If unsure, please select Yes. *

No
Yes

Click here to get your race licence:

BENARABY DRAGWAY IHRA AUSTRALIA EVENT LICENCE

IHRA Day/Event Licence *

Drag & Drop Files, Choose Files 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/Info *

Engine Size *

Crankshaft centreline height *

Less than or equal to 24 inches/610mm
Greater than 24 inches/61cm and less than or equal to 31 inches/785mm
Greater than 31 inches/785mm and less than or equal to 36 inches/915mm
Unsure

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

Sponsor

Bracket (Please Select 1 Only) – Eligible vehicles – Must be a true, operational 4WD (transfer case | centre-locking diff | high / low range etc). *

Petrol – Naturally aspirated 4×4 petrol engine vehicles with capacity up to 6.3 litres, and forced induction (turbo, supercharged or nitrous oxide) with capacity up to 3.5 litres.
Petrol Unlimited – Naturally aspirated 4×4 petrol engine vehicles with capacity 6.4 litres and over, and forced induction (turbo, supercharged or nitrous oxide) with capacity 3.6 litres and over.
Diesel – All 4×4 diesel vehicles

For any 4×2 vehicles please choose best bracket fit from the above, noting that all vehicles that are 2-wheel drive whose manufacturer has a 4-wheel drive equivalent ie Toyota Hilux, Ford Ranger, Holden Rodeo, Ford F Series, Mitsubishi Triton, Mazda BT—50 etc. Any engine size, any engine type, any induction type

Nomination Fee (includes gate entry) *

Benaraby 4WD Drags – $170.00

Crew Entry Pass Adult

Price: $25.00

Entry Pass Child (13-17 years old)

Price: $10.00

Entry Pass Child (12 and under)

Price: $1.00

Entry Pass Pensioner

Price: $5.00

Track Regulations *

I agree to the Track Regulations

You can access the Benaraby Dragway Track Regulation here:

Benaraby Dragway Track Regulations

IHRA Rules & Regulations *

I agree to all IHRA Rules & Regulations

You can access the IRHA Australia rules and regulations using the link below:

IHRA

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 (includes gate entry) – Benaraby 4WD Drags 1 $170.00

Crew Entry Pass Adult 0 $0.00

Entry Pass Child (13-17 years old) 0 $0.00

Entry Pass Child (12 and under) 0 $0.00

Entry Pass Pensioner 0 $0.00

Square surcharge* 1 $0.00

Subtotal

Total $0.00

Payment method *

Credit card via Square – surcharge applies 2.25%*
Bank transfer

Please enter your card details for payment *

Card

Name on Card

Square surcharge*

Price: $0.00

Payment details for bank transfer

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