Membership / Licence Application Form

Please make sure you have a current photo of yourself before continuing with this form as it is a requirement for your application to be successful.
Note that you will be provided a reference number and given the opportunity to provide vehicle information on the next page, which also requires a current photo of your vehicle.

Your Application Details

Title:

Driver's First Name:

Driver's Surname

Date of Birth: (dd/mm/yy)

Postal Address:

Town / City:

Postcode:

Daytime Phone:

Mobile Number:

Email Address:

Attach a Photo

Please attach a photo of yourself for use on the membership card.

Emergency Contact Phone:

Name of Person:

Licence Type:

Fees (GST inclusive) $200.00

Best/Estimated ET

Note: Not required for Associate Members

Race Location

Race Date (dd/mm/yy)

Guardian's Name:

Guardian's Contact Phone

Guardian's Email Address

Guardian's Address:

Town / City:

Postcode:

Is this a new Licence?

New 1-Day Licence Renewing

Existing Licence Number:

Medical certificate expiry: A Medical Certificate is required for all Group One & Unlimited licence holders.
These forms are obtainable from the NZDRA and must be renewed every 3 years. Medical Form

Attach Medical Certificate

Note: Only required if it's a new medical certificate

Expiry Date (dd/mm/yy):

Note: Medical expiry date can be found on front of your old licence.

Civil Drivers Licence Number:

Note: Not required for Junior Dragster, Associate and Volunteer members.

Payment Method

Credit Card (SwipeHQ) Online Banking Cash/Postal Payment

Note: there is a faster turn-around time for credit card applications.

Indemnity

I apply to the New Zealand Drag Racing Association Inc for the issue of a drag racing licence for my own use. I undertake to adhere to the national competition rules of the New Zealand Drag Racing Association Inc, and subsequent conditions and amendments. I am aware of the risks involved in drag racing and will completely absolve the New Zealand Drag Racing Association Inc and all it’s agents from liability for any injuries that may happen to either myself, another competitor or member of the public during competition, or any damage to private property of any description. I understand that this licence is only valid for NZDRA Sanctioned events.

Verification

The information details I am hereby submitting to NZDRA are a true and correct record to the best of my knowledge and belief.