Ihra Competition License Form – Fill Out and Use This PDF

INTERNATIONAL HOT ROD ASSOCIATION

P.O. Box 708, Norwalk, Ohio 44857

Phone: 419-663-6666 Fax: 419-668-6601

IHRA COMPETITION LICENSE FORM

This form must be completely filled out. It will not be processed if there are any omissions.

This Section To Be Filled Out By Competitor – Please Complete Legibly

LICENSE FEE: $60 ET Bracket or $70 Class Competition Application (see Membership, License and Number Application for explanation of fees). $10.00 fee if upgrade from current license.

O New

O Renewal

O Upgrade

O NHRA Transfer (Must enclose copy of NHRA License)

(Each new applicant must enclose copy of valid state driver’s license, over and above a learner’s permit)

Car#______________ Class Applied For______________ IHRA Membership Exp. Date ________________

Name___________________________________________ Social Security Number _____________________

Address _________________________________________ Daytime Phone ____________________________

City _______________ State _______ Zip _____________ Evening Phone ____________________________

Date of Birth ____________________ Age ________ Occupation ___________________________________

฀ Full Bodied Car ฀ Altered฀ Dragster ฀ Motorcycle ฀ Snowmobile

List of IHRA or ET Classes previously competed in: Class ___________ ET ___________ MPH ___________

Base Track _________________________________ Class ___________ ET ___________ MPH ___________

Other Tracks ________________________________ Class ___________ ET ___________ MPH ___________

I, the undersigned, do hereby understand the full provisions of the competitor’s license issued to me by the IHRA, and accept the responsibility of operating my

vehicle in a safe, sportsmanlike manner, and in accordance with all rules and regulations issued by the IHRA, and further, will accept any ruling by the IHRA suspending my driver’s license rights in the event that I fail to strictly follow all of my responsibilities. I agree to abide by all rules, regulations and

requirements contained in the IHRA rulebook, related publications and any amendments issued by the IHRA subsequent to the issuance of my license. I hereby agree and acknowledge that the Release and Waiver of Liability, Assumption of Risk, Indemnity and Rights Agreement which I have signed extends to all acts of negligence or other wrongdoing by the Releasees, and is intended to be as broad and inclusive as is permitted under applicable law, and that if any portion thereof is held invalid, it is agreed that the balance shall remain in full force and effect.

Date: ______________________ Driver’s Signature _______________________________________________

This Section To Be Filled Out By Track / Official and Licensed IHRA Competitors Only

This section not required for 11 sec or slower. 10-10.99 sec needs track official approval. Under 10 seconds requires passes.

(Current IHRA/NHRA License # ___________ Code ________ ) If NHRA transfer, passes not required.
(If passes are made on 1/8 mile track for Class B, you will receive a license restricted to 1/8 mile)
Facility Name ____________________________________________________________ O 1/4 Mile					O 1/8 Mile
1.	330”	E.T. ______	MPH _______	Track Official Witness ________________________________
2. Half Pass		E.T. ______	MPH _______	Track Official Witness ________________________________
3. Half Pass		E.T. ______	MPH _______	Track Official Witness ________________________________
4.	Full Pass	E.T. ______	MPH _______	Track Official Witness ________________________________
5.	Full Pass	E.T. ______	MPH _______	Track Official Witness ________________________________

This license is approved for one classification. Check the box to the left of the specific class.

CLASS	CATEGORY						¼ Mile Times		1/8 Mile Times
	฀ Top Fuel ฀ Nitro Funny Car		฀ Funny Car		฀ Pro Mod ฀ Pro Stock		฀iTimes reflect		฀Classes to left
A	฀ Pro Fuel ฀ Prostalgia Funny Car		฀ Nitro Harley		฀ Nostalgia Fuel Altered
B	฀	Top Sportsman	฀	Top Dragster	฀	ET Bracket	฀		฀
							0 – 7.99		0 – 5.49
C	฀	Quick Rod	฀	Super Stock	฀	ET Bracket	฀	– 8.99	฀	– 5.99
							8.00		5.50
D	฀	Super Rod	฀	Super Stock	฀	ET Bracket	฀	– 10.99	฀	– 6.49
							9.00		6.00
E	฀ Hot Rod		฀ Stock		฀ ET Bracket		฀11.00 Down		฀6.50 Down
M	฀ Motorcycle		฀ Snowmobile

Date	IHRA Licensed Driver Name	IHRA Member #	Signature
_________	______________________________	____________	___________________________________
_________	______________________________	____________	___________________________________
_________	______________________________	____________	___________________________________
Date Approved __________________ Approved By ________________________________________________________
Revised 12/23/10		IHRA OFFICIAL OR TRACK OFFICIAL ONLY