Friday Off Street Drags

Please use this form if you are only attending the Friday Off Street Drags.
Please click here for other options.

PLEASE NOTE: NO ELECTRIC OR HYBRID VEHICLES ALLOWED

Date of Event *

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

First Name *

Last Name *

Date of Birth *

Email *

Phone Number *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Licence Type *

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

Vehicle Year *

Vehicle Make *

Vehicle Model *

Engine Type *

Engine Size *

Will you be bringing a second vehicle? *

No
Yes

Coupon Layout Date

Sponsors (limited to 30 characters for tower software)

Are You a CQDRA Member? *

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 (pets MUST be kept contained in your Pit area ie must not be walked around the venue)

Track Regulations *

I agree to the Track Regulations

IHRA Rules and Regulations *

I agree to all IHRA Rules and Regulations

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

You can access the IHRA Australia rules and regs here: IHRA

Comments / Additional Information

Use this section to tell us anything we need to know about your entry, licence, vehicle, payment, etc. Example: “IHRA licence renewed – new card not received yet:

Next of Kin *

Next of Kin Phone Number *

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

Yes

Coupon

Total

Item Quantity Qty Total

There are no products selected.

Nomination Fee (including entry) – Members – Adult Friday Off Street Meet (CQDRA Member) 1 $70.00

Nomination Fee (including entry) – Members – Junior Friday Off Street Meet (CQDRA Member) 1 $70.00

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

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

Crew Pass Entry – Friday 0 $0.00

Under 18 entry – Friday 0 $0.00

Late fee (if applicable) 1 $20.00

Square surcharge 1 $0.00

Subtotal

Total $20.00

Payment method *

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

Late fee (if applicable) *

Price: $20.00