IPRA NSW Membership |

Membership Application Type*
- I am applying for membership
- I am renewing my membership
Membership Number*
I have been nominated by*
First Last
Membership Number*

Member details
Name*
First Last
Address*
Street Address Suburb State Post Code
Mobile Phone*
Home Phone
Email Address*
Enter Email Confirm Email
- I would like to register my competition vehicle with IPRA
- I would like to complete my driver profile for the IPRA NSW website

Driver Profile Information
Occupation
Facebook Page
Twitter
Linked In
IPRA / Motorsport Involvement
What/Where was the first event that you ever competed in?
This could be a Motorkhana, Skid pan, Supersprint, etc...
What is the first year you ever raced?
Achievements
When listing achievements please include the year that they were achieved.
Quote
Please supply a brief description of why you like racing in Improved Production.
Photo / Images
Member Photo
Accepted file types: jpg, jped, png.
Please upload a photo of yourself (head shot)
Vehicle Photos
Drop files here or
Accepted file types: jpg, jped, png.
Please upload up to 3 images of your vehicle
Vehicle and other details
Class
Make
Model
Engine
Gearbox
Diff
Brakes
Pit crew and helpers
Sponsors
How many sponsors would you like to list?*
Please note, that the listed sponsors must appear on your vehicle
Sponsor 1
Sponsor 1 - Name
Sponsor 1 - Phone
Sponsor 1 - Email
Sponsor 1 - Website
Sponsor 2
Sponsor 2 - Name
Sponsor 2 - Phone
Sponsor 2 - Email
Sponsor 2 - Website
Sponsor 3
Sponsor 3 - Name
Sponsor 3 - Phone
Sponsor 3 - Email
Sponsor 3 - Website
Sponsor 4
Sponsor 4 - Name
Sponsor 4 - Phone
Sponsor 4 - Email
Sponsor 4 - Website
Sponsor 5
Sponsor 5 - Name
Sponsor 5 - Phone
Sponsor 5 - Email
Sponsor 5 - Website

Acceptance / Payment
Membership I am applying for*
- Racing Membership - $120
- Social Membership - $45
IPRA NSW will supply all Racing Members with a 2019 t-shirt as part of your membership.
T-shirt size*
- I hereby apply to renew my membership or become a member of IPRANSW and if accepted, I agree to be bound by the rules & regulations of the IPRANSW.
- I hereby give permission for IPRA NSW to contact me via Phone, SMS or email at any time.
To complete your application, please ensure both boxes above are ticked.
Amount Due
$ 0.00
Payment Type*
- Direct Deposit
- Credit Card (secure online)
Credit Card
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Please ensure you direct deposit amount listed above to;
BSB: 062 313
Acc: 10211610
Name: Improved Production Racing Association of NSW
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Member details