Post completed form to: Central Australian Drag Racing Association,
PO BOX 434, Alice Springs NT 0871
For Information visit our website: www.cadra.com.au or contact us through the website TEST & TUNE, GRUDGE RACING AND
BURNOUT COMPETITION NOMINATION FORM
Saturday 21st March 2015
BRACKET SYMBOL
(Assigned after Qualifying)
ANDRA or CADRA RACER No.
(Assigned by CADRA Officials)
NOTE:
Race Number and Bracket Symbol are assigned by CADRA Officials and must be displayed on vehicle at all times.
DRIVER/
RIDER NAME _______________________________________________________________________________________
ADDRESS __________________________________________________________________ P. CODE ________________
PHONE _________________________ MOB _______________________ EMAIL ________________________________
DRIVERS LICENCE NO. _______________________________ STATE _______________ EXP ____________________
VEHICLE DETAILS _________________________________________________________________________________
YEAR MAKE MODEL BODY STYLE
ENGINE DETAILS ___________________________________________________________________________________
YEAR MAKE TYPE ( I-4, I-6, V8, ROTARY ETC. ) DISPLACEMENT CC or CID SPONSORS AND ANNOUNCER INFO: _________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Please tick all that apply to you
I AM ENTERING: TEST & TUNE OPEN GRUDGE RACING BURNOUT COMP FEES: BURNOUT COMP $40 TEST & TUNE/RACING $40 (TOTAL $80 FOR BURNOUT COMP & RACING) Fees include EACH PIT CREW $5 (Max. Pit Crew : 4 S/C Outlaw;; 3 Modified Eliminator/Super Sedan;; ONE ONLY All other classes) □ DDL (ANDRA DIVISIONAL DAY LICENCE) - see notes Below
NOTES: 1. DDL is required if no ANDRA license
2. DDL Fee is included in Racer Entry Fee
Burnout/Race Fees : $.................
SCRUTINEER: Use the attached ANDRA Extended Scrutineering Program Form 28/1
Pit Crew Fee/s : $.................
TOTAL FEES PAID $................ DECLARATION OF ENTRANTS, DRIVERS & RIDERS
EXCLUSION OF LIABILITY, RELEASE AND ACKNOWLEDGEMENT OF RISK
In exchange for and as a condition of being allowed to enter, participate, or attend this event I/We agree:
To release ASID, CADRA, ANDRA, promoters, sponsor organizations, land owners and lessees, organizers of this event race teams, competitors, their respective servants, officials, representatives and agents (collectively the "Associated Entities") from all liability for death, personal injury (including burns), psychological trauma, loss or damage (including property damage) ("Harm") howsoever arising from participation in or attendance at the event (including any negligence on the part of the Associated Entities), except to the extent where prohibited by law;;
That the Associated Entities do not make any warranty, implied or 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;;
To attend or participate in the event at my/our own risk.
I/We acknowledge that:
The risks associated with attending or participating in this event include the risk that I/We 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;;
The failure or unsuitability of facilities (including grand stands, fences and guard rails and barriers) 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 pro-
vided with the event services by the Associated Entities, agree to abide by all their rules and regulations, agree to read and sign all required entry forms, including the Acknowledgement of Risk statement and other such releases as shall be required by CADRA and ANDRA and their insurers.
I/We agree to be bound by all rules and regulations of ANDRA and CADRA;; to include supplementary regulations per the ASID Racer's Information Sheet, and as verbally given at anytime by ANDRA, CADRA, and ASID officials.
I/We the lawful vehicle owners(s) (Entrants) and/or driver/rider certify that the particulars on this entry form are true and correct in every detail to the best of my/our knowledge.
I/We the lawful owners (Entrants) of the vehicle nominated on this form do hereby apply to enter the vehicle into competi-
tion for this event.
Driver / Rider Signature ___________________________________________________ DATED ____________________
Pit Crew Signature _______________________________________________________ DATED ____________________
Owners Signature(s) _______________________________________________________ DATED ____________________
If Driver/Rider is under age of 18 years, the following Parent/Guardian Consent must be completed:
I (Printed Name) ______________________________________________________________________________________
of (Address) __________________________________________________________________________________________
am the parent/guardian of the above named (the minor) who is under 18 years old. I have read and understand the contents of this document, including the exclusion of liability and assumption of risk, and have explained the contents to the named mi-
nor. I consent to the minor attending / participating in the event at his or her own risk.
Parent / Guardian Signature _____________________________________________________ DATED _________________
HELMET, LONG SLEEVED SHIRT, LONG TROUSERS & COVERED SHOES REQUIRED FOR ALL COMPETITORS
SUPPORT DRAG RACING: PLEASE - NO BYO ALCOHOL & NO GLASS CONTAINERS !
ESP COMPETITOR DECLARATION
I (the competitor)
of:
hereby state that I or my agent have inspected the vehicle against all items on this form and confirm that the entered
vehicle complies with all relevant minimum Safety and Class Eligibility requirements as detailed in the ANDRA Rulebook.
The vehicle will be made available for Compliance Audits as requested by the appointed Officials.
Licence No
Eliminator
Class
Category One – Safety Critical
Helmet STD/DATE
Protective Clothing
Safety Harness DATE
Roll over protection
Bellhousing/Auto Trans Shield
Cyl Head Restraints
Clutch / Chain Guard
Steering system
Suspension system
Seat and mountings
Wheels/Tyres
Fuel Shutoff
Tech Inspection
Parachutes
Throttle Return
Fire extinguisher
Fire System
Braking system
Supercharger Restraints
Wheelie Bars
Lanyard / Ignition Kill
Category Two – Safety Non Critical
Engine & Transmission
Clutch & Flywheel
Neutral Safety Switch (auto trans)
Battery/Battery Mounting
Battery Isolation Switch
Fuel tank / fuel cell
Liquid Overflow
Lower Engine Containment Device
Lubrication & Cooling System
Firewall
Fuel Lines
Wing Mounts
Category Three – Class Compliance and Non Safety
Engine capacity & components
Transmission Type
Body Dimensions & Aerodynamics
Licence Number & Class displayed
General vehicle presentation
Fuel Blend …………………..................
Supercharger Overdrive …………%
Supercharger is not modified from OEM specifications
Supercharger is ANDRA approved type only
Electronic devices
No reactive control devices employed or fitted
Fuel Additives ………........................…………
X = Not applicable
* Please note Fuel Blend and Supercharger overdrive
√ = Item checked
COMPETITOR DECLARATION: I am aware that where any breach of the Rules or Regulations of ANDRA is found during a
Compliance Audit I render myself liable to Tribunal Action and/or appropriate penalties and my signature below indicates
my acceptance of this undertaking.
Competitors Signature: _____________________________________________ Date: _________________________
Officials Checks
Holds appropriate Licence
Licence is valid
Logbook is valid
Logbook checked for outstanding entries
Compliance sticker issued
Confirm competitor entry details
Completed Indemnity Statement
Witness competitor signature
Armband issued
OFFICIALS DECLARATION: In signing this form as an official I declare that I am satisfied that the competitor has correctly
completed the ESP form where necessary
Officials Name
Signature: _____________________________________________ Position: ________________________________
BURNOUT COMPETITION