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OFFICAL ENTRY FORM FOR OUR EVENT CAUSEY PARK MORPETH ,NORTHUMBERLAND 23rd/24th AUGUST 2008 CRAMLINGTON
& DISTRICT ................... / ........................... / 2008 AUTOCROSS
ENTRY FORM ENTRANT..........................................................................................................................................................................................
ADDRESS......................................................................................................................................................................................... .......................................................................................................................................................................................................... .......................................................................................................................................................................................................... .......................................................................................................................................................................................................... POST
CODE................................................................................................................................................................................... TEL
No: HOME.................................................WORK................................................
MOBILE................................................ COMPETITION
LICENCE NUMBER.................................. CLUB.............................................................................................. CHAMPIONSHIP A.N.E.C.C.C
.Y
/ N BORDER
..Y
/ N SCOTTISH
...Y
/ N Registration
No
. Car:
Make
.. Model
Capacity
.
Class
. Shared
Car No (if applicable)
.. This
entry form together with your entry fee of
£
55.00 payable to C.D.M.C. Should be sent to the entry secretary If entered for both days fee is £100.00 please state days entering - SAT .......... / SUN .......... or BOTH ......... PLEASE NOTE: LATE ENTRY WILL INCUR A £15.00 CHARGE
NOTE: CLOSING DATE IS THE TUESDAY BEFORE THE EVENT NO LATER entries received after the closing date will be classed as late entry and you will be charged the late entry fee
INDEMNIFICATION I
have read the supplementary regulations issued for this meeting and agree to be
bound by them and the international code of the FIA and the general regulations
of the RAC motor sports association ltd in consideration of the acceptance of
this entry of my being permitted to take part in this meeting. I
agree to save harmless and keep indemnified to the M.S.A Motor sports association ltd., The landowners, Cramlington &
district motor club and their respective officials, servants, representatives
and agents from and against all action, claims, cost, expenses and demands in
respect of death, injury, loss or damage to property or person or myself my
driver (s), or mechanics howsoever caused arising out or in connection with this
entry of my taking part in this meeting and not withstanding that the same may
have been contributed to our occasioned by the negligence of said bodies, their officials,servants,representatives or agent (s ) Furthermore
in respect of any parts of the event where third party insurance under the RTA
is not compulsory this agreement shall in addition to the parties named above
also extend to all and any other competitors and their servants and agents, and
to all actions, claims, expenses and demands in respect to loss or damage to the
person, or property of myself, my driver(s), mechanics and associated personnel I
declare that to the best of my belief the driver(s) posses the standard of
competence necessary for an event of this type to which this entry relates and
the car entered is suitable and roadworthy for the event having regard to the
speeds which will be reached. IF
AN ENTRANT IS UNDER 18 YRS OF AGE THE APPROPRIATE PARENT OR GUARDIAN MUST
COUNTERSIGN THIS FORM. Signature of Entrant.........................................................................My age is (if applicable state over 17 yrs)........................................ Signature of driver......................................................Signature Entrants / Drivers Parent / Guardian................................................... Name of Parent or Guardian........................................................................................................................................................................ Address........................................................................................................................................................................................................... ..................................................................................................................................................Post Code.................................................... Next of kin................................................................................................................... ...................................................................................................................................... Return to C.Coxon 77,Mount Pleasant Court Throckley Newcastle Upon Tyne NE15 / 9AZ
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