entryform

Camel Vale Motor Club Ltd

ENTRY FORM

DATE OF EVENT ...........................................................................................................................

DRIVER'S FULL NAME ...........................................................................................................................

ADDRESS ................................................................................................................................................

................................. Post Code................................. Tel No........................................................................

VEHICLE ENTERED ............................................ REG. NO. ......................................

CLASS: .......................................

NAMES AND ADDRESSES OF ANY PASSENGERS ...................................................

...........................................................Post Code ................................Tel 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, the Supplementary Regulations for this event and agree to be bound by them. I declare that I am physically and mentally fit to take part in the event and I am competent to do so. I acknowledge that I understand the nature and type of the competition and the potential risk inherent with motor sport and agree to accept that risk. Further, I understand that all persons having a connection with the promotion and/or organisation and/or conduct of the event are insured against loss or injury caused through their negligence.

Drivers Signature ................................................................

Name and address of relative/friend to be informed in case of serious accident:

Signature of any Passenger(s)................................................................................................

If an entrant is under the age of 18 years this form must be countersigned by a Parent/Guardian whose full name and address must be given below.

I confirm 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 me up to a maxima set out in section Z.

Name ............................................................... Relationship to driver ................................

Address ................................................................................................................................

...................................... Post Code ................................... Signature ...............................................

I enclose herewith Entry Fee as detailed in the Regulations (please note that no entry can be accepted unless accompanied by the appropriate fee).

Entry Fee £

CVMC Membership, (If required) £

______

Total £



	Camel Vale Motor Club Ltd ENTRY FORM DATE OF EVENT ........................................................................................................................... DRIVER'S FULL NAME ........................................................................................................................... ADDRESS ................................................................................................................................................ ................................. Post Code................................. Tel No........................................................................ VEHICLE ENTERED ............................................ REG. NO. ...................................... CLASS: ....................................... NAMES AND ADDRESSES OF ANY PASSENGERS ................................................... . ...........................................................Post Code ................................Tel 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, the Supplementary Regulations for this event and agree to be bound by them. I declare that I am physically and mentally fit to take part in the event and I am competent to do so. I acknowledge that I understand the nature and type of the competition and the potential risk inherent with motor sport and agree to accept that risk. Further, I understand that all persons having a connection with the promotion and/or organisation and/or conduct of the event are insured against loss or injury caused through their negligence. Drivers Signature ................................................................ Name and address of relative/friend to be informed in case of serious accident: Signature of any Passenger(s)................................................................................................ If an entrant is under the age of 18 years this form must be countersigned by a Parent/Guardian whose full name and address must be given below. I confirm 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 me up to a maxima set out in section Z. Name ............................................................... Relationship to driver ................................ Address ................................................................................................................................ ...................................... Post Code ................................... Signature ............................................... I enclose herewith Entry Fee as detailed in the Regulations (please note that no entry can be accepted unless accompanied by the appropriate fee). Entry Fee £ CVMC Membership, (If required) £ ______ Total £