IHRA TECH INSPECTORS LOG BOOK

Transcription

IHRA TECH INSPECTORS
If you would like to upgrade to an IHRA license the forms are provided below along with
the details and samples on how to fill out the IHRA license forms.
Please see below for a list of the current IHRA Tech Inspectors and their contact
numbers.
Grant Little
Dave Moyle
Ray Pratt – Bikes
Ian Hilder – Bikes
Trevor Williams
Chris Johnston
Alan Williams
Colin Welsh
Murray Buckingham
Alan Taylor
Simon Fowke
Earl Nunn – Bikes
Spike Allen – Bikes
Whangarei
West Auckland
Auckland
Auckland
Auckland
Pukekohe
Taupo
Wellington
Nelson
Christchurch
Christchurch
Christchurch
Mt Maunganui
09 435 3278 a/h
09 839 7227
09 308 1633
021 932 174
021 762 144
0274 782 767
021 275 2388
04 528 8774
03 576 5585
03 347 2245
03 354 0387
0274 823 264
021 763 760 / 07 575 0311
LOG BOOK
Once your bike or car has passed tech inspection, please send the white copy of the
form along with $20 to the below address for your log book.
IHRA NZ
Marua Automotive,
P.O.Box 11610
Ellerslie
Auckland
Paul 021 411 429
We will endeavour to keep you informed as other Tech Inspectors come on board. If you
have any questions on our dates, licenses or tech inspections, please don't hesitate to
call us.
See you at the Track
Web: http://FramAutoliteDragway.co.nz
Email: [email protected]
P.O. Box 552, Pukekohe
Tel: 09 238 5564
Mob: 0274 056 060
Fax: 09 2385538
INTERNATIONAL HOT ROD ASSOCIATION
P.O. Box 708, Norwalk, Ohio 44857
Phone: 419-663-6666 Fax: 419-668-6601
2011 IHRA MEMBERSHIP, LICENSE & NUMBER APPLICATION
O ET BRACKET MEMBERSHIP AND LICENSE: Please note: All Competitors must have Competition License Form
accompany this application. Includes *IHRA Insurance Program, Rule Book, Jacket Patch, Decal, Membership and License
Card, 1 Year Subscription to Drag Review Magazine.
$60.00 one year _______________
*INSURANCE VALID AT IHRA SANCTIONED TRACKS
$105.00 two years ______________
IN NORTH AMERICA ONLY
$155.00 three years _____________
O SUMMIT SUPER SERIES MEMBERSHIP, AND NUMBER: Please note: All Competitors must have Competition
License Form accompany this application. Includes *IHRA Insurance Program, Rule Book, Jacket Patch, Decal, Membership
and License, 1 Year Subscription to Drag Review Magazine.
SSS LICENSE ONLY – CANNOT RUN NITRO JAM
SSS PLUS ET LICENSE– CAN RUN NITRO JAM OR
OR TEAM FINALS EVENTS WITH THIS LICENSE
TEAM FINALS EVENTS WITH THIS LICENSE
$50.00
one year ______
$60.00
one year ______
$85.00
two years ______
$105.00 two years ______
$125.00 three years ______
$155.00 three years ______
*INSURANCE VALID AT IHRA SANCTIONED TRACKS IN NORTH AMERICA ONLY.
Car Number ________ Track Name ___________________(You must declare track to be issued a number)
Electronics_____________________ No Electronics __________________ (must declare)
O SUMMIT PRO AM / PRO COMPETITION MEMBERSHIP, LICENSE AND NUMBER: Please note: All
Competitors must have Competition License Form accompany this application. Includes *IHRA Insurance Program, Rule
Book, Jacket Patch, Decal, Membership and License Card, Number, 1 Year Subscription to Drag Review Magazine.
*INSURANCE VALID AT IHRA SANCTIONED TRACKS IN NORTH AMERICA ONLY
United States and Puerto Rico
Class ________________
Permanent Number Requested _____________ $70.00 one year _______________
$125.00 two years ______________
$185.00 three years _____________
O Additional Number Requested _______ Class __________________
$10.00 per year ________________
O CREW MEMBERSHIP AND FAN: Includes *IHRA Insurance Program, Rule Book, Jacket Patch, Decal, Membership
Card, 1Year Subscription to Drag Review Magazine. U.S. and Puerto Rico
$50.00 one year _______________
$85.00 two years _______________ $125.00 three years _____________
O Canadian and Mexico Members add $50.00 per year for postage to above fees $50.00 per year ________________
O Foreign members add $75.00 per year for postage to above fees.
$75.00 per year ________________
O ASSOCIATE MEMBERSHIP: Does not include Rule Book or Drag Review. Household must have a full member at the
same address with the same membership expiration date.
(Also select E.T. Bracket, Class Competition, or Crew/Fan above)
subtract $10.00 per year _______________
Full member Membership # _____________________ and Expiration Date ___________________
*INSURANCE VALID AT IHRA SANCTIONED EVENTS AT IHRA MEMBER TRACKS IN NORTH AMERICA ONLY.
THIS FORM MUST BE FILLED OUT COMPLETELY
TOTAL$
_______________
Name __________________________________________E-MAIL ADDRESS___________________________
Address _______________________________________________________
Phone _____________________________
City ____________________________________________ State _____________________ Zip ___________________
I AM ALSO AN NHRA MEMBER [ ] Yes
[ ] No
O Cash
O Check O Money Order
O Visa
O MasterCard
O Discover O AmEx
Credit Card # _____________________________________________________ Exp Date ________________
Print Name on Card ________________________________ Signature _________________________________
DRIVERS SIGNATURE: _____________________________________________________________________________________
"By signing this application, I certify that I have read and agree to abide by all the rules, regulations and agreements of the IHRA rulebook and related publications. I understand
that additions and amendments to the IHRA rulebook will appear online and in DRM throughout the year."
(Revised 12/22/10)
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 _______
3. Half Pass
E.T. ______
MPH _______
4. Full Pass
E.T. ______
MPH _______
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
A
CATEGORY
Top Fuel Nitro Funny Car
Pro Fuel
Prostalgia Funny Car
Funny Car
Nitro Harley
Pro Mod Pro Stock
Nostalgia Fuel Altered
B
C
D
E
M
Top Sportsman
Quick Rod
Super Rod
Hot Rod
Motorcycle
Top Dragster
Super Stock
Super Stock
Stock
Snowmobile
ET Bracket
ET Bracket
ET Bracket
ET Bracket
Date
_________
_________
_________
IHRA Licensed Driver Name
______________________________
______________________________
______________________________
IHRA Member #
____________
____________
____________
¼ Mile Times
iTimes reflect
0 – 7.99
8.00 – 8.99
9.00 – 10.99
11.00 Down
1/8 Mile Times
Classes to left
0 – 5.49
5.50 – 5.99
6.00 – 6.49
6.50 Down
Signature
___________________________________
___________________________________
___________________________________
Date Approved __________________ Approved By ________________________________________________________
IHRA OFFICIAL OR TRACK OFFICIAL ONLY
PO BOX 708 9 ½ EAST MAIN STREET
NORWALK, OHIO 44857
PHONE: 419-663-6666 FAX: 419-668-6601
MEDICAL PHYSICAL FORM
Name: ________________________________ Date of Birth: ________________________
Address: ____________________________________________________________________
City: _______________________________ State: _____________ Zip: ________________
Signature: _____________________________________ Date: _______________________
MEDICAL HISTORY
Y
N
HAVE YOU EVER HAD ANY OF THE FOLLOWING: (For each “yes” checked describe conditions in remarks)
CONDITION
Y
N
CONDITION
Y N
CONDITION
Y N
CONDITION
a. frequent or severe
headaches
b. dizziness or fainting
spells
c. unconsciousness for
any reason
d. eye trouble except
glasses
e. hay fever
f. asthma
g. heart trouble
h. high or low
blood pressure
i. stomach trouble
j. kidney stone or
blood in urine
k. sugar or
albumin in urine
l. epilepsy or fits
m. nervous trouble
of any sort
n. any drug or
narcotic habit
o. excessive
drinking habit
p. attempted
suicide
q. motion sickness
requiring drugs
r. military medical
discharge
s. medical rejection
from service
t. admission to
hospital
u. rejection for life
insurance
v. record of traffic
convictions
w. record of other
convictions
x. other illnesses
REMARKS: (if no changes since last report, so state) _______________________________________________
MEDICAL TREATMENT WITHIN THE PAST FIVE YEARS
Date
Name of Physician Consulted
_________________________________________________________________________
SIGNATURE OF APPLICANT
Reason
______________________________
DATE
APPLICANTS’ DECLARATION: I hereby certify that all statements and answers provided by me in this examination form are complete
and true to the best of my knowledge, and I agree that they are to be considered part of the basis for insurance of any IHRA certificate to
me.
REPORT OF MEDICAL EXAMINATION
NORMAL ABNORMAL CHECK EACH ITEM IN APPROPRIATE BOX
1. Head, face, neck and scalp
2. Nose
3. Sinuses
4. Mouth and throat
5. Ears, general (internal and external canals)
6. Ear Drums (perforation)
7. Eyes, general (visual activity under items 50 &51)
8. Ophthalmoscopic
9. Pupils (equality and reaction)
10. Ocular mobility (associated parallel movement, mystaginus)
11. Lungs and chest (including breasts)
12. Heart ( thrust, size, rhythm, sounds)
13. Vascular system
14. Abdomen and viscera (including hernia)
15. Anus and rectum (hemorrhoids, fistula, prostate)
16. Endocrine system
17. G-U system
18. Upper and lower extremities ( strength, range of motion)
19. Spine other musculoskeletal
20. Identifying body marks, scar, tattoos
21. Skin and lymphatic
22. Neuralgic (tendon reflexes, equilibrium, senses, coordination)
23. Psychiatric (specify any personality deviation)
24. General Systemic
[
Corrective lens required while driving
] NO * if previously
[ ] YES
“yes”, please include
explanation of change
FIELD OF VISION
[ ] Normal
[
LEFT EYE
Albumen
Systolic
URINALYSIS
Sugar
NEAR VISION
Right eye
20/
20/
Left eye
20/
20/
Both eyes
20/
20/
PULSE (Wrist)
BLOOD PRESSURE
Recumbent MM
Mercury
DISTANT VISION
BLOOD SUGAR TEST
(both fasting and 2 hour post prandial, required only if sugar is found in urine No S.I. Units))
FASTING
2-HOUR P.P.
HgA 1C
COMMENTS
FIELD OF VISION
RIGHT EYE
] Abnormal
NOTES: Describe every abnormality in
detail, enter applicable item number
before each comment. Use additional
sheets if necessary and attach to this
form.
Diastolic
Resting
After Exercise
ECG (Date)
OTHER TESTS
2 minutes after exercise
DISQUALIFYING DEFECTS/LIMITATIONS:
COMMENTS ON HISTORY AND FINDINGS:
APPLICANTS NAME:
FURTHER EVALUATION REQUIROED (EXPLAIN):
PHYSICALLY ACCEPTABLE
MEDICAL EXAMINER’S DECLARATION: I hereby cerify that I personally examined the applicant named on this medical examination repot, and that this report and
any attachment embodies my findings completely and correctly.
EXAMINATION DATE
MEDICAL EXAMINER’S NAME AND ADDRESS
MEDICAL EXAMINER’S SIGNATURE
Phone: 419-663-6666 Fax: 419-668-6601
IHRA JUNIOR DRAGSTER LICENSE FORM
FULL MEMBERSHIP: *IHRA Insurance program, Rule Book, Jacket Patch, Decal, Membership and License Card, Car Number, 1
Year Subscription to Drag Review Magazine.
__________ O 1 Year United States and Puerto Rico
$40.00 (US Funds)
__________ O 1 Year Canada and Foreign
$90.00 (US Funds)
__________ O 1 Year Canada and Foreign
$40.00 (US Funds)
(Does not include subscription to Drag Review)
__________ O Associate Membership
$30.00 (US Funds)
Does not include Rule Book or Drag Review. Household must have a full member at the same address with
the same membership expiration date
Full Membership # ____________________ Expiration Date ______________________
Car#________ Class Applied For______________ Date of Birth ___________________ Age _____________
Name___________________________________________ Social Security Number _____________________
Address _________________________________________ Daytime Phone ____________________________
City _______________ State _______ Zip _____________ Evening Phone ____________________________
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 _______________________________________________
Date: _____________________ Parent or Legal Guardian’s Signature:____________________________
*VALID AT IHRA SANCTIONED EVENTS AT IHRA MEMBER TRACKS AND EVENTS ONLY
O Cash
O Check
O Money Order
O Visa
O MasterCard
O Discover
Credit Card # _____________________________________________________ Exp Date ________________
Print Name on Card ________________________________ Signature ________________________________
This Section To Be Filled Out By Track or IHRA Official Only
Facility Name ____________________________________________________Date; _________________________________
1. Launch
(Beginners class only)
2. Launch
(Beginners class only)
3. Half Pass
E.T. ______
MPH _______ Track Official Witness ________________________________
4. Half Pass
E.T. ______
5. Full Pass
E.T. ______
6. Full Pass
E.T. ______
7. Full Pass
E.T. ______
8. Full Pass
E.T. ______
9. Full Pass
E.T. ______
10. Full Pass
E.T _______
_________ *Beginners Class: Age 8 or 9, ET limited to 12.90 and slower. Must make passes 1 through 6.
________ *Advanced Class: Age 10-17, ET restricted to 8.90 and slower. Must make passes 3 through 8.
________ *Masters Class: Age 12 and up, minimum 1 year licensed prior experience, ET 7.90 and slower. Must make 3
full passes at 8.90 and slower and 3 full passes at 7.90 and slower. Must make passes 5 through 10.
*See IHRA rulebook for complete rules, requirements and restrictions.
Date Approved __________________ Approved By ________________________________________________________
(Revised 06/21/06)
IHRA OFFICIAL OR TRACK OFFICIAL ONLY
COPY OF BIRTH CERTIFICATE MUST ACCOMPANY THIS APPLICATION
INFORMATION FOR UPGRADING TO AN IHRA LICENSE
TOP ALCOHOL & TOP DOOR SLAMMER-GROUP ONE
A NZ Top Alcohol dragster and Altered license change over to an IHRA Top Dragster license
and a NZ Top Alcohol Funny Car and Top Door Slammer license changes over to an IHRA
Top Sportsman License. To obtain one of these license you must have a current medical
certificate, your existing current certificate is acceptable (see back of your license).
Medicals need updating every three years. You need to fill out the IHRA Competition License
Form and a 2011 IHRA Membership, License & Number Application (see Samples). IHRA need
a copy of your civil driver’s license and a copy of both sides of your existing NZDRA License.
IHRA will accept a NZDRA license as long as it has not expired more than 3 years.
COMP, T/ STREET, SUPER SEDAN, MODIFIED, S/G AND ALL BIKES
All cars and bikes running quicker than 11.00 must have a license; you do not have to
produce a medical certificate unless an Area Steward requests one. Licenses are classed by
ET.
B ET Bracket 0-7.99
C ET Bracket 8.00-8.99
D ET Bracket 9.00-10.99
You need to fill out the IHRA Competition License Form and a 2011 IHRA Membership,
License & Number Application (see Samples). IHRA need a copy of your civil driver’s license
and a copy of both sides your existing NZDRA License. IHRA will accept a NZDRA license as
long as it has not expired more than 3 years.
JUNIOR DRAGSTER
There are 3 license grades for junior dragster, Beginners, Advanced and Masters; these are
determined by age and ET. You need to fill out the IHRA Junior Dragster License Form (see
Sample). IHRA need a copy of a birth certificate and a copy of both sides of your existing
NZDRA License. IHRA will accept a NZDRA license as long as it has not expired more than 3
years.
PLEASE NOTE: All prices on forms are in US dollars; you can put your credit card details on the
forms and fax direct to IHRA or scan and email direct to [email protected] . If you don’t
have a credit card you can give forms and equivalent money to Fram and we will process
for you. If you don’t want the Drag Review Magazine, just cross this part out. The cost for the
Magazine is USD$75 for postage per year. All new licenses can be processed at the track. If
you have any queries please give Gary a call on 0274 056060.
Web: http://FramAutoliteDragway.co.nz
Email: [email protected]
P.O. Box 552, Pukekohe
Tel: 09 238 5564
Mob: 0274 056 060
Fax: 09 2385538

IHRA TECH INSPECTORS LOG BOOK

Transcription

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