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://benarabydragway.com.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

Subtotal

Total $0.00