Nomination Form

Competitor details

Full name:

Home phone:

Mobile:

E-mail:

Address:

Suburb:

State:

Postcode:

For competitors under 18 years of age (minimum 6 years)

Age:

Name of parent / guardian:

Address of parent / guardian:

Suburb:

State:

Postcode:

Bike details

Make of bike:

Engine capacity:

Fuel type:

Modifications (if any):

Class entering

V8

Harley super modified

Harley modified

Harley street

Sportster

Street bike

Street bike modified

Quad

Quad junior

Moto X open

Moto X 450xx

Moto X 250cc

Moto X 125cc

Moto X junior

Moto X junior 250cc

Moto X junior 125cc

Pee Wee

Entry fees

Rules

• All unlimited V8 bikes to be fitted with lanyard engine cut out.
• All bikes to have at least 1 good operational brake.
• All quads to have operational brake systems.
• All riders / drivers must have a good helmet and eye protection.
• All riders / drivers must have minimum long sleeve shirt, long pants, boots above the ankles and gloves.
• All bikes will be subject to scrutineering before a racing number plate is issued.

Terms and conditions

NQ Dirt Drags, OW Promotions and the event organisers will not take any responsibility for injury to any person or any loss or damage suffered to property, whether directly or indirectly, no matter how, or by whom caused.

I release, waive and hold harmless NQ Dirt Drags, OW Promotions and the event organisers and/or employees of all claims, losses, damages or expenses which may arise during or in conjunction with my participation in the NQ Dirt Drags at the Sarina Show Grounds on 2nd and 3rd July 2011, including any claims for damage caused by negligence of any of them, together with any costs, including legal fees that may be incurred as a result of such a claim whether valid or not.

I have read and agree to the terms above.