RM_StatsEvent Dates *Select an optionFEBRUARY 24-25thMARCH 24-25thAPRIL 21-22ndMAY 26-27thJUNE 2-3rdJUNE 23-24thJULY 21-22ndAUGUST 4-5thAUGUST 25-27thSEPTEMBER 22-23rdOCTOBER 27-28thNOVEMBER 17-18thVendor name for this pre-nom form (submit multiple forms if needed) *Select an optionNumber Plate FactoryGlow as you GoEmail *First Name *Last Name *Mobile Number * 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. You may simply photograph your signature on paper and upload it. WEEKEND VENDOR FEESSpecial Vendor Fee Weekend Fee - Inc 1 Friday and 1 Saturday armband (ONLY select 1) ($ 75.00) × Additional Friday armbands - EACH. Select 1 for each helper ($ 5.00) × Additional Saturday armbands - EACH. Select 1 for each helper ($ 10.00) × NOTE: You MUST already have a signed Service Agreement Form on file with CQDRA in order to be eligible to submit this Online nomination form. CQDRA must also have all of your current Licence and Insurance details on file. 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 Failure to submit and pay will mean that your documents will NOT be available at the gate when you arrive. 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
NOTE: You MUST already have a signed Service Agreement Form on file with CQDRA in order to be eligible to submit this Online nomination form. CQDRA must also have all of your current Licence and Insurance details on file. 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 Failure to submit and pay will mean that your documents will NOT be available at the gate when you arrive.
