Entry Form – Mayhem – Benaraby Dragway

Date of Event *

Have you raced at Benaraby Dragway before? *

Entrant Details

Name *

First

Last

Email *

Phone *

Date of Birth *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Licence Details

Licence Type *

Will your vehicle be running an Elapsed Time (ET) between 10.00 seconds and 12.99 seconds 1/4-mile? If unsure, please select Yes. *

Yes
No

The purchase of an IHRA Event Licence is required for any vehicle running between 10.00 seconds and 12.99 seconds ET (1/4-mile). Please click here to get your Event Licence. Note – you will need to take a screenshot of your purchase to upload on this form.

Upload your IHRA Event Licence Screenshot *

Drag & Drop Files, Choose Files to Upload

Vehicle Details

Vehicle Year *

Vehicle Make *

Vehicle Model *

Engine Type / Size *

Crankshaft Centreline Height *

Less than or equal to 24″ (610mm)
Greater than 24″ (610mm) and less than or equal to 31″ (785mm)
Greater than 31″ (785mm) and less than or equal to 36″ (915mm)
Unsure

Vehicle in /

Upload a Photo of your Vehicle (to be used in Social Media Promo) *

Drag & Drop Files, Choose Files to Upload

Brackets | Burnout Competition | Passenger Rides

Eligible vehicles:
4×4 – must be a true, operational 4-wheel drive (transfer case, centre-locking diff, high/low range etc)
4×2 – 2-wheel drive whose manufacturer has a 4-wheel drive equivalent ie Toyota Hilux, Ford Ranger, Holden Rodeo, Ford F Series, Mitsubishi Triton, Mazda BT50 etc. Any engine size, any engine type, any induction type.

Bracket *

Petrol Limited – Naturally aspirated 4×4 (or 4×2 equivalents) 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 (or 4×2 equivalents) 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 (or 4×2 equivalents) diesel vehicles

Passenger Rides (No Cost) – During Practice Session Only *

Yes, I would like to take a Passenger
No, I won’t be taking a Passenger

Passenger Ride Information

What Do Passengers Need to Wear?
- Long sleeve top (fully enclosed)
- Full-length trousers (no nylon)
- Enclosed shoes with socks
- A full or open-face helmet (less than 10 years old)
How Do We Sign Up for a Passenger Ride?
- Driver and Passenger must present at the Office to fill in and sign Passenger Ride Declaration Forms
- Driver, Passenger and Vehicle must present at Scrutineering for safety checks and to get a Passenger sticker for their windscreen.

Burnout Competition (No Cost) *

Yes, I will be participating in the Burnout Competition
No, I won’t be participating in the Burnout Competition

Nominations | Crew Passes

Entry Fees *

Nomination Fee (includes gate entry for Driver) – $170.00

Crew Pass: Adult

Price: $20.00

Crew Pass: Pensioner

Price: $5.00

Crew Pass: Child (13 – 17 years)

Price: $10.00

Crew Pass: Child (12 & under)

Price: $1.00

Next of Kin *

First

Last

Next of Kin Contact Number *

Acknowledgements and Declarations

Track Regulations *

I agree to the Track Regulations

IHRA Rules & Regulations *

I agree to IHRA’s Rules & Regulations

Declaration *

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

You can access Benaraby Dragway’s Track Regulations here.

You can access IHRA’s Rules & Regulations here.

Payment Method *

Bank transfer (please arrange payment within 24 hours to BSB: 034-126 Account: 232 427)
Debit / Credit Card (2.25% surcharge applies)

Total

Item Quantity Qty Total

There are no products selected.

Entry Fees – Nomination Fee (includes gate entry for Driver) 1 $170.00

Crew Pass: Adult 0 $0.00

Crew Pass: Pensioner 0 $0.00

Crew Pass: Child (13 – 17 years) 0 $0.00

Crew Pass: Child (12 & under) 0 $0.00

Square Surcharge 1 $0.00

Subtotal

Total $0.00

Square Surcharge

Price: $0.00

Square *

Card

Name on Card