CQ GOLDRUSH 660 – Benaraby Dragway

PLEASE NOTE: NO ELECTRIC OR HYBRID VEHICLES ALLOWED

Date of Event *

Rules

Any power adder

Any tyre – full slick allowed

Transbrake allowed

No delay boxes

6.37 & quicker requires tech Breakout = loss

Call-outs allowed

Passenger rides allowed

Schedule

Practice — 11am to 2:30pm (unlimited runs)

Qualifying — 3pm to 5pm (2 rounds)

Racing — From 6pm (3 rounds)

Is this the first time you have raced at Benaraby Dragway? *

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 Licence Number *

IHRA Licence Type *

IHRA Professional Licence Category *

IHRA Sportsman Licence Category *

IHRA Sportsman Street Licence Category *

IHRA Sportsman Junior Competition Licence Category *

Licence expiry date: *

Please enter your IHRA Licence expiry date

Drivers Licence Number *

Please enter your drivers licence number here.

Will your car be running an Elapsed Time (ET) between 10.00 sec to 12.99 sec 1/4 mile or Motorcycles slower than 9.00 sec 1/4 mile? If unsure, please select Yes. Note: All motorcyclists must hold an IHRA licence – either a full competition licence (for ET quicker than 9.00 seconds) or an Event Licence (for ET slower than 9.00 seconds). *

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

Engine Size *

High-Resolution Image of Race Vehicle *

Drag & Drop Files, Choose Files to Upload

Please upload a high-resolution image of your race vehicle for use in event promotion and advertising. By submitting this image, you consent to its use across digital and print marketing materials. Preferred formats: JPG or PNG. Minimum size: 1MB. Images should be clear, in focus, and free of watermarks where possible.

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

Bracket *

Are you a CQDRA Member? *

CQDRA Member Number *

Nomination fee (including gate entry) *

CQ GOLDRUSH 660 – $200.00

Crew Entry Pass

Price: $10.00

Under 18 Entry Pass

Price: $1.00

Will you be bringing a pet to the track? *

No
Yes

If Yes, you agree to 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

Payment method *

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

Total

Item Quantity Qty Total

There are no products selected.

Nomination fee (including gate entry) – CQ GOLDRUSH 660 1 $200.00

Crew Entry Pass 0 $0.00

Under 18 Entry Pass 0 $0.00

Late fee (if applicable) 1 $0.00

Square surcharge* 1 $0.00

Subtotal

Total $0.00

Coupon

pet CONSENT Regulations

Late fee (if applicable) *

Price: $0.00

Square surcharge*

Price: $0.00

Please enter your card details for payment *

Card

Name on Card

Payment details for nomination

To secure your race nomination please arrange a bank deposit within 24 hours: Westpac Bank BSB: 034 126 Account: 232427 Ref: Surname/bracket