REGISTRATION FORM

1/8^th Mile Drag Racing Event, Sunday February 28th 2010 Warrnambool City Dragway

Name of Driver …………………………………………………

Address ………………………………………………………….

Email Address (optional) : ……………………………………..

Phone No: …………………Occupation……………………….

Licence No ………………… Date of Birth ……………………

ANDRA Member Yes/No : Membership No ………………….

WADDRA Member Yes/No

Make of Vehicle : …………………..Year : …………………...

Model : ……………………………..Colour : …………………

Type of Engine : …………………...

Vehicle Sponsors : ……………………………………………………………………

Please note a maximum of two crew members per vehicle

Signed : …………………………… Date : ……………………