2018 ihra australia membership, license & number ... AWS
INTERNATIONAL HOT ROD ASSOCIATION 1555 Palm Beach Lakes Blvd, Suite 1105 West Palm Beach, Florida 33401 Phone: 561-337-3015 [email protected]
2018 IHRA AUSTRALIA MEMBERSHIP, LICENSE & NUMBER APPLICATION (PAGE 1) THIS FORM AND THE COMPETITION LICENSE FORM MUST ACCOMPANY ANY NEW APPLICATION MEMBERSHIP & COMPETITION LICENSE: (Includes Rule Book App, Decals & Membership/License Card) 1) SELECT TYPE OF APPLICATION:
[ ] New Application [ ] Renewal
2) SELECT LENGTH OF MEMBERSHIP: [ ] $170.00 one year
JUNIOR DRAGSTER - [ ] $90.00 one year
Mem. ID # _______________ (IF RENEWAL)
[ ] $320.00 two years [ ] $160.00 two years
[ ] $475.00 three years [ ] $235.00 three years
(NOTE) ONLINE SUBMISSIONS RECEIVE A $10 PER YEAR DISCOUNT – VISIT www.ihra.com)
3) SELECT CLASSES AND CAR NUMBERS: (NOTE – IF YOU DO NOT HOLD A CURRENT ANDRA LICENSE AND CAR NUMBER, YOUR CAR NUMBER WILL BE 6000 OR HIGHER)
CLASS _________________________
PERMANENT CAR NUMBER __________________
CLASS _________________________
PERMANENT CAR NUMBER __________________
CLASS _________________________
PERMANENT CAR NUMBER __________________
GENERAL MEMBERSHIP: Includes Rule Book App, Decals & Membership Card – NO Competition License – for crew, family, etc. $90.00 one year ______
$160.00 two years ______
$235.00 three years ______
(NOTE) ONLINE SUBMISSIONS RECEIVE A $10 PER YEAR DISCOUNT – VISIT www.ihra.com) NOTE: ALL FUNDS WILL BE PROCESSED IN U.S. DOLLARS
ASSOCIATE MEMBERSHIP: (Household must have one OTHER current full member at the same address) Subtract $10.00 per year __________
Full Member Membership # ________________ Expiration Date ______________
Name __________________________________________ Email Address _______________________________ Postal Address ________________________________________ Daytime Phone ____________________ M/F ______ City __________________________________________ State/Terr __________________ Post Code ________________ I am also an ANDRA member
PAYMENT METHOD
[ ] Yes [ ] Cash [ ] Visa
[ ] No [ ] Check [ ] M/C
(If yes, please include copy of your ANDRA license with these forms) TOTAL AMOUNT PAID
[ ] Money Order [ ] Discover [ ] AmEx
Credit Card # ____________________________
Security Code ____ Exp.____ - ____ MONTH
SIGNATURE: ______________________________________
$ ALL FUNDS IN U.S. DOLLARS
YEAR
By signing this application, I certify that I have read and agree to abide by all the rules, regulations and agreements of the IHRA rulebook and related publications. I understand that additions and amendments to the IHRA rulebook will appear online. (Effective 1/1/18
INTERNATIONAL HOT ROD ASSOCIATION 1555 Palm Beach Lakes Blvd, Suite 1105 West Palm Beach, Florida 33401 Phone: 561-337-3015 [email protected]
2018 IHRA AUSTRALIA COMPETITION LICENSE FORM (PAGE 2) All “NEW” applicants must enclose a photocopy of their civil driver’s license with these forms. NOTE: a learner’s permit is not acceptable This Section To Be Filled Out By Applicant [ ] New
[ ] Renewal (Mem ID# ____________)
Car# ______________
Note: (Page 1 is also required)
[ ] Class Change
Class Applied For_____________________
[ ] ANDRA Transfer (Copy of current ANDRA license required)
Home Track _____________________________________
Name__________________________________________________________
Date of Birth ___________________ M/F ____
Address ________________________________________________________
Email ___________________________________
City _______________________________________
[ ] Full Bodied Car
State _______________
[ ] Altered/Funny Car
Post Code ____________
[ ] Dragster
CLASS / CATEGORY C1
[ ] Top Fuel [ ] Top Bike [ ] Exhibition
[ ] Pro Slammer [ ] Pro Alcohol
[ ] Pro Stock [ ] Pro Bike
C2
[ ] Competition [ ] Competition Bike
[ ] Supercharged Outlaws [ ] Top Sportsman
[ ] Super Stock [ ] Super Compact
C3
[ ] Modified [ ] Modified Bike
[ ] Super Sedan [ ] Super Gas
[ ] Pro Radial
No Medical Required
STR
[ ] Super Street
* Medical Required
JD
[ ] Junior Dragster
* Medical Required
[ ] Motorcycle 400 Meter Times
200 Meter Times
t 0 – 9:99 – Car t 0 – 9:49 – Bike
0 to 6.39 – Car 0 to 6.14 - Bike
10.00- Slower - Car 9.50 - Slower - Bike
6.40 - Slower - Car 6.15 - Slower - Bike
N/A
8.00 – 15.00
Copy of birth certificate required for all NEW Junior Dragster applications
I, the undersigned, do hereby understand the full provisions of the competitor’s license issued to me by the IHRA, and accept the responsibility of operating my vehicle in a safe, sportsmanlike manner, and in accordance with all rules and regulations issued by the IHRA, and further, will accept any ruling by the IHRA suspending my driver’s license rights in the event that I fail to strictly follow all of my responsibilities. I agree to abide by all rules, regulations and requirements contained in the IHRA Australian rulebook, related publications and any amendments issued by the IHRA subsequent to the issuance of my license. I hereby agree and acknowledge that the Release and Waiver of Liability, Assumption of Risk, Indemnity and Rights Agreement which I have signed extends to all acts of negligence or other wrongdoing by the Releases, and is intended to be as broad and inclusive as is permitted under applicable law, and that if any portion thereof is held invalid, it is agreed that the balance shall remain in full force and effect.
Date: ______________________
Driver’s Signature: ____________________________________________________________
This Section Is to be Filled Out by Track/IHRA Official and Licensed IHRA Competitors Only (Current IHRA or ANDRA License # ___________ Code ________) If ANDRA transfer, passes not required but copy of ANDRA license required. (If passes are made on 200meter track, you will receive a license restricted to 200 meters) Facility Name _________________________________________________________________________ [ ] 400 meters [ ] 200 meters 1. 100 meters E.T. _________ MPH _________ Track Official Witness ____________________________________ 2. Half Pass E.T. _________ MPH _________ Track Official Witness ____________________________________ 3. Half Pass E.T. _________ MPH _________ Track Official Witness ____________________________________ 4. Full Pass E.T. _________ MPH _________ Track Official Witness ____________________________________ 5. Full Pass E.T. _________ MPH _________ Track Official Witness ____________________________________ LICENSED DRIVER SIGNATURES REQUIRED FOR CLASS A PRO DRIVERS ONLY
Date _________ _________ _________
IHRA/ANDRA Licensed Driver/Rider ______________________________ ______________________________ ______________________________
IHRA Member # _____________ _____________ _____________
Signature ___________________________________ ___________________________________ ___________________________________
Date Approved __________________ Approved By ________________________________________________________ 1/1/18 IHRA OR TRACK OFFICIAL ONLY
2018 IHRA AUSTRALIA MEMBERSHIP, LICENSE & NUMBER APPLICATION (PAGE 1) THIS FORM AND THE COMPETITION LICENSE FORM MUST ACCOMPANY ANY NEW APPLICATION MEMBERSHIP & COMPETITION LICENSE: (Includes Rule Book App, Decals & Membership/License Card) 1) SELECT TYPE OF APPLICATION:
[ ] New Application [ ] Renewal
2) SELECT LENGTH OF MEMBERSHIP: [ ] $170.00 one year
JUNIOR DRAGSTER - [ ] $90.00 one year
Mem. ID # _______________ (IF RENEWAL)
[ ] $320.00 two years [ ] $160.00 two years
[ ] $475.00 three years [ ] $235.00 three years
(NOTE) ONLINE SUBMISSIONS RECEIVE A $10 PER YEAR DISCOUNT – VISIT www.ihra.com)
3) SELECT CLASSES AND CAR NUMBERS: (NOTE – IF YOU DO NOT HOLD A CURRENT ANDRA LICENSE AND CAR NUMBER, YOUR CAR NUMBER WILL BE 6000 OR HIGHER)
CLASS _________________________
PERMANENT CAR NUMBER __________________
CLASS _________________________
PERMANENT CAR NUMBER __________________
CLASS _________________________
PERMANENT CAR NUMBER __________________
GENERAL MEMBERSHIP: Includes Rule Book App, Decals & Membership Card – NO Competition License – for crew, family, etc. $90.00 one year ______
$160.00 two years ______
$235.00 three years ______
(NOTE) ONLINE SUBMISSIONS RECEIVE A $10 PER YEAR DISCOUNT – VISIT www.ihra.com) NOTE: ALL FUNDS WILL BE PROCESSED IN U.S. DOLLARS
ASSOCIATE MEMBERSHIP: (Household must have one OTHER current full member at the same address) Subtract $10.00 per year __________
Full Member Membership # ________________ Expiration Date ______________
Name __________________________________________ Email Address _______________________________ Postal Address ________________________________________ Daytime Phone ____________________ M/F ______ City __________________________________________ State/Terr __________________ Post Code ________________ I am also an ANDRA member
PAYMENT METHOD
[ ] Yes [ ] Cash [ ] Visa
[ ] No [ ] Check [ ] M/C
(If yes, please include copy of your ANDRA license with these forms) TOTAL AMOUNT PAID
[ ] Money Order [ ] Discover [ ] AmEx
Credit Card # ____________________________
Security Code ____ Exp.____ - ____ MONTH
SIGNATURE: ______________________________________
$ ALL FUNDS IN U.S. DOLLARS
YEAR
By signing this application, I certify that I have read and agree to abide by all the rules, regulations and agreements of the IHRA rulebook and related publications. I understand that additions and amendments to the IHRA rulebook will appear online. (Effective 1/1/18
INTERNATIONAL HOT ROD ASSOCIATION 1555 Palm Beach Lakes Blvd, Suite 1105 West Palm Beach, Florida 33401 Phone: 561-337-3015 [email protected]
2018 IHRA AUSTRALIA COMPETITION LICENSE FORM (PAGE 2) All “NEW” applicants must enclose a photocopy of their civil driver’s license with these forms. NOTE: a learner’s permit is not acceptable This Section To Be Filled Out By Applicant [ ] New
[ ] Renewal (Mem ID# ____________)
Car# ______________
Note: (Page 1 is also required)
[ ] Class Change
Class Applied For_____________________
[ ] ANDRA Transfer (Copy of current ANDRA license required)
Home Track _____________________________________
Name__________________________________________________________
Date of Birth ___________________ M/F ____
Address ________________________________________________________
Email ___________________________________
City _______________________________________
[ ] Full Bodied Car
State _______________
[ ] Altered/Funny Car
Post Code ____________
[ ] Dragster
CLASS / CATEGORY C1
[ ] Top Fuel [ ] Top Bike [ ] Exhibition
[ ] Pro Slammer [ ] Pro Alcohol
[ ] Pro Stock [ ] Pro Bike
C2
[ ] Competition [ ] Competition Bike
[ ] Supercharged Outlaws [ ] Top Sportsman
[ ] Super Stock [ ] Super Compact
C3
[ ] Modified [ ] Modified Bike
[ ] Super Sedan [ ] Super Gas
[ ] Pro Radial
No Medical Required
STR
[ ] Super Street
* Medical Required
JD
[ ] Junior Dragster
* Medical Required
[ ] Motorcycle 400 Meter Times
200 Meter Times
t 0 – 9:99 – Car t 0 – 9:49 – Bike
0 to 6.39 – Car 0 to 6.14 - Bike
10.00- Slower - Car 9.50 - Slower - Bike
6.40 - Slower - Car 6.15 - Slower - Bike
N/A
8.00 – 15.00
Copy of birth certificate required for all NEW Junior Dragster applications
I, the undersigned, do hereby understand the full provisions of the competitor’s license issued to me by the IHRA, and accept the responsibility of operating my vehicle in a safe, sportsmanlike manner, and in accordance with all rules and regulations issued by the IHRA, and further, will accept any ruling by the IHRA suspending my driver’s license rights in the event that I fail to strictly follow all of my responsibilities. I agree to abide by all rules, regulations and requirements contained in the IHRA Australian rulebook, related publications and any amendments issued by the IHRA subsequent to the issuance of my license. I hereby agree and acknowledge that the Release and Waiver of Liability, Assumption of Risk, Indemnity and Rights Agreement which I have signed extends to all acts of negligence or other wrongdoing by the Releases, and is intended to be as broad and inclusive as is permitted under applicable law, and that if any portion thereof is held invalid, it is agreed that the balance shall remain in full force and effect.
Date: ______________________
Driver’s Signature: ____________________________________________________________
This Section Is to be Filled Out by Track/IHRA Official and Licensed IHRA Competitors Only (Current IHRA or ANDRA License # ___________ Code ________) If ANDRA transfer, passes not required but copy of ANDRA license required. (If passes are made on 200meter track, you will receive a license restricted to 200 meters) Facility Name _________________________________________________________________________ [ ] 400 meters [ ] 200 meters 1. 100 meters E.T. _________ MPH _________ Track Official Witness ____________________________________ 2. Half Pass E.T. _________ MPH _________ Track Official Witness ____________________________________ 3. Half Pass E.T. _________ MPH _________ Track Official Witness ____________________________________ 4. Full Pass E.T. _________ MPH _________ Track Official Witness ____________________________________ 5. Full Pass E.T. _________ MPH _________ Track Official Witness ____________________________________ LICENSED DRIVER SIGNATURES REQUIRED FOR CLASS A PRO DRIVERS ONLY
Date _________ _________ _________
IHRA/ANDRA Licensed Driver/Rider ______________________________ ______________________________ ______________________________
IHRA Member # _____________ _____________ _____________
Signature ___________________________________ ___________________________________ ___________________________________
Date Approved __________________ Approved By ________________________________________________________ 1/1/18 IHRA OR TRACK OFFICIAL ONLY
