Application for National Record

Member Number*

Class*

Car Number*

Check if 1/4 Mile Record Is Needed

1/4 Mile Record

Official Record 1/4 Mile E.T.

Official Record 1/4 Mile MPH

Check if 1/8 Mile Record Is Needed

1/8 Mile Record

Official Record 1/8 Mile E.T.*

Official Record 1/8 Mile MPH*

Name of Track Record Was At*

Date of Record*

Engine Year*

Engine Make*

Vehicle Make*

Vehicle Model*

Vehicle Year*

Please provide the following information in the order listed, in 60 spaces below

Information contained in these 60 spaces will appear in the

NATIONAL DRAGSTER Record Listings

For example: Driver First Name, Driver Last Name, Driver Hometown, Drive Home State Abbreviation, Owner Name, Major Sponsor Name.

All punctuation (,.()! Etc.) and spaces between words count as a space. NHRA reserves the right to edit material.

CERTIFICATES WILL BE AWARDED TO DRIVER ONLY UNLESS SPECIFIED, MORE THAN 60 CHARACTERS CAN BE USED FOR AWARDEE

Number of Certificates To Be Printed*

You are entiled to 1 free certificate per record. EACH additional certificate is subject to a $10 Fee. Before mailing, the NHRA Technical Department will contact you to collect payment.

When an additional certificate is requested, the information submitted on this form will be printed X times.

If you wish to print an additional certificate with a different subject line (example: if you are giving one of your sponors a certificate), you will need to fill out an additional form with their information in the "National Dragster Listing" section.

NATIONAL DRAGSTER LISTING*

0/60

MAIL TO:

Full Name*

Address*

Phone Number*

Email Address*

Upload Timeslip

Upload a File

APPLICATION FOR NATIONAL RECORD