CAMEL VALE MOTOR CLUB
ENTRY FORM
Date and Title of Event
Driver's full name .. Tel No ..
Address
Postcode ..
Do you hold a valid Road Traffic Act Driver's Licence YES/ NO
Passenger's/Navigators Name and Address
..
Name & Address of any other passengers
..
Competition Licence No Club
Vehicle entered: . CC class
Registration No. .. Novice YES/ NO
DECLARATION OF INDEMNITY
I declare that I have been given the opportunity to read the General Regulations of the Motor Sports Association and, if any, Supplemental Regulations for this event and agree to be bound by them. I declare that I am physically and mentally fit to take part in this event and I am competent to do so. I acknowledge that I understand the nature and type of competition and potential risk inherent with motor sport and agree to accept that risk. Further, I understand that all persons having any connection with the promotion and/or organisation and/or conduct of the event are insured against loss or injury caused through their negligence.
I understand that should I a the time of the event be suffering from any disability whether permanent or temporary, which is likely to affect prejudicially my normal control of my vehicle, I may not take part unless I have declared such disability to the ASN which has following such declaration issued a licence which permits me to do so.
I declare that to the best of my belief the driver(s) possess(es) the standard of competence necessary for an event of the type to which this entry relates and that the vehicle entered is suitable and roadworthy for the event having regard to the course and speeds, which will be reached. I declare that the use of the vehicle hereby entered will be covered by insurance as required by the Law, which is valid for such part of this event as shall take place on roads as defined by the Law.
Driver's signature .. (state age if under 18)
Passenger's signature .. (state age if under 18)
If I am the parent/guardian/guarantor of the driver: I under that I shall have the right to be present during any procedure being carried out under the Supplementary Regulations issued for this event and the General Regulations of the MSA.
As a parent/guardian/guarantor: I confirm that I have acquainted myself with the MSA General Regulations, agree to pay any appropriate charges and fees pursuant to those Regulations (to include any appendices thereto) and hereby agree to be bound by those Regulations and submit myself without reserve to the consequences resulting from those Regulations (and any subsequent alteration thereof). Further I agree to pay as liquidated damages any fines imposed upon my up to the maximum set out in Section Z.
Note: Where the parent/guardian/guarantor is not present there must be a representative who must produce a written and signed authorisation to so act from the parent/guardian/guarantor.
Full Name of Parent/Guardian/Guarantor .
Address ..Tel: No .
Signature . Relationship .
Date ..
I enclose herewith entry fee as detailed in the Supplementary Regulations (please note that no entry can be accepted unless accompanied by the appropriate fee)
Held under the General Regulations of the Motor Sports Association Ltd (incorporating the provisions of the International Sporting Code of the FIA and the Supplementary Regulations)
ENTRY FEE
£
£ CVMC membership (if appropriate) £
_________________ TOTAL £Please make cheques payable to Camel Vale Motor Lub Ltd
