IHRA COMPETITION LICENSE FORM

1 international HOT ROD association . 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). $ 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.

2 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.

3 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.

4 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. 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 _____ MPH _____ Track Official Witness _____. 2. Half Pass _____ MPH _____ Track Official Witness _____. 3. Half Pass _____ MPH _____ Track Official Witness _____. 4. Full Pass _____ MPH _____ Track Official Witness _____.

5 5. Full Pass _____ MPH _____ Track Official Witness _____ . This LICENSE is approved for one classification. Check the box to the left of the specific class. CLASS CATEGORY 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 0 C Quick Rod Super Stock ET Bracket D Super Rod Super Stock ET Bracket E Hot Rod Stock ET Bracket Down Down M Motorcycle Snowmobile Date IHRA Licensed Driver Name IHRA Member # Signature _____ _____ _____ _____. _____ _____ _____ _____. _____ _____ _____ _____. Date Approved _____ Approved By _____.

6 Revised 12/23/10 IHRA OFFICIAL OR TRACK OFFICIAL ONLY.