Oxford Motor Club - Bocado AutoSolo - Sunday 26thApril2015
Driver / Name:Address:
Tel No:
E-Mail:
Competition Licence Number: / Championships: Delete as necessary
CMSG :
BTRDA Autosolo:
BTRDA Challenge:
ASWMC:
Club:
Next of Kin
(In the event of a serious accident) / Name: / Relationship:
Address and Tel No:
Car Details / Make/Model:
Colour: / Registration:
Year:
Engine Size:
Fuel Type: PETROL / DIESEL
Forced Induction: YES / NO / Class Entered: / Event Entered:
Delete as necessary
National B
Clubmans
PCA
Payment Type / Cheque / Bank Transfer
Entry Fee (Payable to Oxford Motor Club) / Nat B & Clubmans £38.00
PCA £32.00
Oxford MC Membership (until December 2015) / £12.00
Total
DECLARATION: '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 and competent to take part in the event. I understand that motorsport is dangerous and accidents causing death, injury, disability and property damage can and do happen. I understand that these risks may give rise to my suffering personal injury or other loss and I acknowledge and accept these risks.
‘In consideration of the acceptance of this entry Iagree that neither any one of or any combination ofthe MSA and its associated clubs, the organisers, thetrack owners or other occupiers, the promoters andtheir respective officers, servants, representativesand agents (the Parties”) shall have any liability forloss or damage which may be sustained or incurredby me as a result of participation in the Event.Nothing in this clause is intended to or shall bedeemed to exclude or limit liability for death orpersonal injury. To the fullest extent permitted by lawI agree to indemnify and hold harmless each of theParties in respect of any loss or damage whatsoeverand howsoever arising from my participation in theEvent.'I declare that to the best of my belief the driver(s)possess(es) the standard of competence necessaryfor an event of the type to which this entry relates andthat the vehicle entered is suitable and roadworthy forthe event having regard to the course and the speedswhich will be reached'.
DRIVER'S SIGNATURE...... My age is ...... (if applicable, state 'over 18 years')
Please Note: - If Entrant or Driver is under 18 years of age, please read A.34. The following MUST be completed by that person's Parent or Guardian. They must either endorse the signing on form on the day, or a letter stating event, date, permission etc (basically showing that the Parent/Guardian/Guarantor knows what is happening) must be produced.I declare that I am the Parent/Guardian/Guarantor of the Entrant/Driver
Name...... Address......
...... Telephone......
Send to:- Shirley Blackwell – 14 Matlock Close, Brownsover, Rugby, Warks. CV21 1LB
E-Mail:-