Welcome to the Summerland Drags nomination form. 

All entrants are required to fill this form in before competing. All components marked with an * are required to be filled in for the form to be successful.

Fill in this online form 
OR 
Completed nominations to be forwarded to: 
Summerland Drags, PO Box 675, Lismore NSW 2480.

The first 150 Paid Nominations ONLY will be accepted. There is a nomination fee of $50 per vehicle which must be received before your nomination will be accepted. If you have multiple vehicles you must nominate them separately on separate nomination forms.

Summerland Drags reserves the right to accept or reject any nomination.     31 July 2010

*Drivers Name:  (Full Name Please)

*Phone Number:

*Class Competing: Please Choose the class of vehicle Motorcycle 4 Cylinder Street 6 Cylinder Street 8 Cylinder Street Turbo/ Super Charged/NOS Exhibition Class

*Type Of Vehicle:

*Rego Plate: (if Vehicle unregistered or racecar type NA)

Engine Size: Cubic Centimetres OR
                         Cubic Inches

Transmission: Manuel OR Automatic

*Are you an ANDRA Member? Please Choose Yes/No Yes No If yes state membership number:

Please list any modifications to the vehicle:

Please list any sponsors if applicable:

There is a nomination fee of $50. This includes car entry and admission for the driver. 

Pay via: Credit Card, Cheque/Money Order

Credit Card Number. (no spaces please)
Credit Card Expiry Date: / (ie. 01/10)
Three Digit verification number on back of card:
Name on card:
(Card statement will have payment receipted to DML Holdings Pty Ltd.)

*Postal Address:

*Email Address:

If you do not have a credit card a cheque payment may be made to
Summerland Drags PO Box 675, Lismore NSW 2480