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APPLICATION FOR MEMBERSHIP 2023

Do you want to join the winning team at Benaraby? CQDRA are always seeking positive minded people to join our club and help promote our regional venue and the sport of Drag Racing. We love to socialize online and at our events, spreading the good word about Benaraby Dragway and all the great times we have. If this sounds like you, please complete the application below so the current Management Committee can review for consideration. Good luck, and here's to a brighter future for Benaraby with you on the team!

FYI - CQDRA annual Membership expires on December 31st each year.
Please note: All applications received after October 31st will be applied towards next year and will be reviewed for approval in January.

Email^*

Type of Membership (all amounts include GST)

Membership Packages

Family (2 Adults & 3 Children 16 Years & Under) ($ 65)
Single ($ 45)

Member 1

First Name^*

Last Name^*

Home Address

Address Line 1

City

State or Region

Zip

Mobile Number

Gender^*

Male
Female

Occupation

ANDRA Licence # if applicable:

Date of Birth

Email Address^*

Signature- Upload here. Not 100% required at this time.

Member 2

First Name

Last Name

Mobile Number

Gender

Male
Female

Occupation

ANDRA Licence #if applicable:

Date of Birth

Email Address

Signature- Upload here. Not 100% required at this time.

Child 1

First Name

Last Name

Date of Birth

Gender

Male
Female

ANDRA Licence # if applicable:

Child 2

First Name

Last Name

Date of Birth

Gender

Male
Female

ANDRA Licence # if applicable:

Child 3

First Name

Last Name

Date of Birth

Gender

Male
Female

ANDRA Licence # if applicable:

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