Membership Level -
Membership Status - LAPSED
Name *
Date of Birth
Address *
Suburb *
Postcode *
Email Address *
Home Number
Work Number
Mobile *
Emergency Contact Name *
Emergency Contact Phone *
QR (RACERS) Licence No. *
QTCC Web Site Password - (For log in) *
Make
Model
Colour
Engine Type and Capacity/Cylinders
VIN
Racing Number
Is your vehicle QTCC Log Booked?
Yes / No (If not please make contact with the Technical Committee)
Do you have a AASA National licence and a "RACERS" Clubman licence?
Yes / No
Which racing group do you think you should be classified in?
A - QR National under 1min 21sec per lap
B - QR National between 1min 21 and 1min 25 per lap
C - QR National greater than 1min 25sec per lap
Have you ever had from any club (racing or otherwise) a membership termination or rejection?
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