<p>QUEENSLAND LIGHTNING SPRINT RACING ASSOCIATION QLSRA</p><p>EMAIL: [email protected] or [email protected] Mob: 0404 040 783</p><p>QLD TITLE REGISTRATION FORM – Season 2016/2017</p><p>I/We being the owner/s ______</p><p>Of (full address) ______State: ______P/C:______</p><p>Phone (H): ______(M): ______</p><p>Email: ______</p><p>In signing this registration I confirm the vehicle complies with the Queensland Lightning Sprint Racing Association Class Specifications.</p><p>Car Number: ______</p><p>State vehicle garaged: ______</p><p>Name of Driver/s:______</p><p>Colour (Main):______(Minor):______</p><p>Make of Engine:______</p><p>Engine Seal Number:______</p><p>Sponsors: ______</p><p>NOMINATION FEE: $100 REF: qldtitle (and your car number) Nominations Close: 12:00pm Noon Monday 20 March 2017</p><p>EFT details – Acc Name: QLSRA, HERITAGE BANK BSB: 638-010 Acc No: 13179365</p><p>Applicants Signature: ______Date: ______</p>