RM_StatsCOME AND TRY DATESSelect an optionMARCH 18thMAY 20thSEPTEMBER 16thNOVEMBER 11thANDRA RACE LICENCE NUMBER - OR - DRIVERS LICENCE NUMBER *ANDRA or applicable licence - if you have any. If no race licence, you MUST select "QLD or other Drivers Licence" and purchase Day Licence (good all weekend) *Select an optionANDRA OFF-STREET LICENCEANDRA SSLANDRA Group 3 UDLANDRA Group 2 UDLANDRA Group 1 UDLA/JB (Jr Drag Bikes)A/JD (Jr Drag Cars)Single Event LicenceQLD or other Drivers LicenceDATE OF BIRTH * Email *RACER'S First Name *RACER'S Last Name *Address Address Line 1 City State or Region POST CODE Mobile Number Vehicle InformationMake/ Model *Engine Capacity *SponsorsOccupation EXCLUSION OF LIABILITY, RELEASE AND ASSUMPTION OF RISK – ENTRANTS/DRIVERS/RIDERS I/We being the entrant/s and/or driver and/or rider, certify that the particulars on the Entry Form are true and correct in every particular, to the best of my/our knowledge and belief. I/We declare that I/We have read and understood the Supplementary Regulations issued for the event, and agree to be bound by them and the provisions of the Competition Rules of the Australian National Drag Racing Association Inc. (ANDRA). In Exchange for being able to enter, attend or participate in the event I/WE agree: . to release ANDRA, promoters, sponsors organisations, land owners and lessees, organisers of the event, their respective servants, officials, representatives and agents (collectively, the “Associated Entities”) from all liability for my death, personal injury (including burns), psychological trauma, loss or damage (including property damage) (“harm”) howsoever arising from my participation in or attendance at the event, except to the extent prohibited by law; . that ANDRA and the Associated Entities do not make any warranty, implied and express, that the event services will be provided with due care and skill or that any materials provided in connection with the services will be fit for the purpose for which they are supplied; and . to attend or participate in the event at my/our own risk. I/We acknowledge that: . The risks associated with attending or participating in the event include the risk that I may suffer harm as a result of: . Motor vehicles (or parts of them) colliding with other motor vehicles, persons or property; . Acts of violence and other harmful acts (whether intentional or inadvertent) committed by persons attending or participating in the event; and . The failure or unsuitability of facilities (including grand-stands, fences and guard rails) to ensure the safety of persons or property at the event. . Motor sport is dangerous and that accidents causing harm can and do happen and may happen to me/us. I/We accept the conditions of, and acknowledge the risks arising from, attending or participating in the event and being provided with the event services by ANDRA and the Associated EntitiesSignature- Upload here. Not 100% required at this time. You MUST see office track staff first when you arrive. ENTRY FEECOME AND TRY DAY FOR MEMBERS COME AND TRY DAY Nomination ($ 50) DAY LICENCE (non ANDRA licence holders) ($ 20) If you are utilising a Day Licence, you may purchase CATEGORY 2 Personal Accident Insurance for the duration of the event. If you are an ANDRA member, or ANDRA licence holder, you may purchase CATEGORY 1 Personal Accident insurance for the duration of the event. Both are very valuable resources in the event you have an accident, and details of their coverage can be found in the ANDRA Rulebook. See page 42, paragraph 1.6.6 PERSONAL ACCIDENT INSURANCE. https://issuu.com/andradragracing/docs/014059_andra_rulebook20192020_hires NOTE: If you are an ANDRA licence holder, you are automatically covered by Category 2 insurance at no additional charge. Day Licence holders can NOT obtain the Category 1 insurance.PERSONAL ACCIDENT INSURANCE CATEGORY 1 ($ 20) CATEGORY 2 ($ 10) CONDITIONS OF ENTRY *CONDITIONS OF ENTRY please readTHE EVENT will be held under the rules of the Australian National Drag Racing Association (ANDRA) AND WHATEVER SUPPLEMENTARY REGULATIONS APPLY as per Racer Mail Out etc. ALL COMPETITORS must complete and submit an entry form together with the ENTRY Fee and are bound by the rules governing the event. Incomplete entry forms will not be accepted. COMPETITOR’S PRE-NOMS will be held at the office for collection on Race Day. REFUND OF ENTRY FEE: No refunds will be made. If an event is cancelled or postponed, fees will be credited against the next scheduled event. If a competitor is unable to attend an event for which he has entered, the Entry Fee will be credited against the next Event. VEHICLE OWNER AND DRIVER agrees to permit the Organisers and/or ANDRA to impound the vehicle for investigation should any accident or incident occurs. THE ORGANISERS may at any time refuse to accept, or reject any entry without assigning any reason therefore and without being in any way whatsoever liable to any person whatsoever for so doing. VEHICLE OWNER AND DRIVER agree to permit the Organisers and their Assigns to use their names and pictures of themselves and of their race vehicles for publicity, advertising and endorsements (including newspapers, films, magazines, radio, television and posters etc) both before and after the Event and do hereby relinquish their rights to any photography in connection with the Event and give their permission to publish or sell or otherwise dispose of said photography as the Organisers may so desire. IN consideration of your acceptance of my/our application to use Benaraby Raceway, I/we jointly and severally agree to keep INDEMNIFIED and to save harmless the Central Queensland Drag Racing Association Inc. and their respective officers, officials and employees representatives and agents from and against all actions, claims, costs, expenses and demands in respect of death, injury, loss of or damage to a person or property of myself/ourselves my/our driver(s) passenger(s) or mechanic(s) as the case may be howsoever caused arising out of or in connection with my/our taking part in any meeting trial or practice session whether official or unofficial and notwithstanding that the same may have been contributed or occasioned by the negligence of the said Central Queensland Drag Racing Association Inc. or their officers, officials, employees, representatives or agents. As a further condition of the acceptance of this application I/we DO HEREBY for each of us and each of our heirs, executors and administrat ors RELEASE Central Queensland Drag Racing Association Inc. or all its members, officers, officials, employees, representatives or agents collectively and individually from all actions, suits, claims and demands for any loss, damage, injury or cost incurred, sustained or made by me and/or members arising directly or indirectly out of my/our participation in any capacity whatsoever at any time at Benaraby Raceway notwithstanding whether or not any such loss, damage, injury or cost shall have been caused or contributed to be any act omission or negligence on the part of Central Queensland Drag Racing Association Inc. or its members, officers, officials, employees, representatives or agents or in any defect in the Drag Strip or appurtenances thereto apparatus appertaining thereto and further I/we DO HEREBY JOINTLY AND SEVERALLY CONVENANT to indemnify and to keep indemnified the said Central Queensland Drag Racing Association Inc. all its members, officers, officials, employees, representatives or agents collectively and individually against all actions claims and demands for any injury, loss, expense, damage or cost suffered, sustained or incurred or made by or to any person, firm or corporations including the said Central Queensland Drag Racing Association Inc. its members, officers, officials, employees, representatives or agents (or any defect in the Drag Strip or appurtenances thereto) and further I/we DO HEREBY AGREE AND DECLARE that in the interpretation of this clause the meaning thereof shall not be restricted by anything contained in the preceding clause. I/We hereby certify my/our acceptance of the above rules and conditions of entry.PLEASE NOTE, if you do NOT have PAYPAL, you will still submit this form. PayPal will allow you to "Pay with a Card". You may have to scroll to see this option after clicking "SUBMIT". PLEASE give the website 10-15 seconds to transition to PayPal Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu.
EXCLUSION OF LIABILITY, RELEASE AND ASSUMPTION OF RISK – ENTRANTS/DRIVERS/RIDERS I/We being the entrant/s and/or driver and/or rider, certify that the particulars on the Entry Form are true and correct in every particular, to the best of my/our knowledge and belief. I/We declare that I/We have read and understood the Supplementary Regulations issued for the event, and agree to be bound by them and the provisions of the Competition Rules of the Australian National Drag Racing Association Inc. (ANDRA). In Exchange for being able to enter, attend or participate in the event I/WE agree: . to release ANDRA, promoters, sponsors organisations, land owners and lessees, organisers of the event, their respective servants, officials, representatives and agents (collectively, the “Associated Entities”) from all liability for my death, personal injury (including burns), psychological trauma, loss or damage (including property damage) (“harm”) howsoever arising from my participation in or attendance at the event, except to the extent prohibited by law; . that ANDRA and the Associated Entities do not make any warranty, implied and express, that the event services will be provided with due care and skill or that any materials provided in connection with the services will be fit for the purpose for which they are supplied; and . to attend or participate in the event at my/our own risk. I/We acknowledge that: . The risks associated with attending or participating in the event include the risk that I may suffer harm as a result of: . Motor vehicles (or parts of them) colliding with other motor vehicles, persons or property; . Acts of violence and other harmful acts (whether intentional or inadvertent) committed by persons attending or participating in the event; and . The failure or unsuitability of facilities (including grand-stands, fences and guard rails) to ensure the safety of persons or property at the event. . Motor sport is dangerous and that accidents causing harm can and do happen and may happen to me/us. I/We accept the conditions of, and acknowledge the risks arising from, attending or participating in the event and being provided with the event services by ANDRA and the Associated Entities
If you are utilising a Day Licence, you may purchase CATEGORY 2 Personal Accident Insurance for the duration of the event. If you are an ANDRA member, or ANDRA licence holder, you may purchase CATEGORY 1 Personal Accident insurance for the duration of the event. Both are very valuable resources in the event you have an accident, and details of their coverage can be found in the ANDRA Rulebook. See page 42, paragraph 1.6.6 PERSONAL ACCIDENT INSURANCE. https://issuu.com/andradragracing/docs/014059_andra_rulebook20192020_hires NOTE: If you are an ANDRA licence holder, you are automatically covered by Category 2 insurance at no additional charge. Day Licence holders can NOT obtain the Category 1 insurance.
PLEASE NOTE, if you do NOT have PAYPAL, you will still submit this form. PayPal will allow you to "Pay with a Card". You may have to scroll to see this option after clicking "SUBMIT". PLEASE give the website 10-15 seconds to transition to PayPal
