Entry Form

Print this form and then print your scrutineering form on the back

You are invited to seek legal advice before signing this document.

Date of Event: _____ / ______/ ______Venue: ______

Entrant Name: ______

Full address: ______

Mobile: ______E-mail: ______

Car Make: ______Model: ______Year: ______Colour: ______

Registered: Yes / NoClass: _____Engine capacity (cc): ______Induction: Natural / Forced

Tyre Brand: ______Model & Type: ______Tyre change since last event: Yes/No

Driver 1 name: ______

Full address: ______

Mobile: ______E-mail: ______

Competition licence no.: ______Expiry Date: _____ / ______/ ______

Driver 2 name: ______

Full address: ______

Mobile: ______E-mail: ______

Competition licence no.: ______Expiry Date: _____ / ______/ ______

ENTRANTS DISCLAIMER AND DECLARATION

I (We) ______of ______, being the entrant(s) of the vehicle described on this entry form wish to enter this vehicle for the above mentioned meeting. I (We) declare that the information filled in this form is true and correct to the best of my (our) knowledge and belief.

ENTRANTS AND DRIVER DISCLAIMER AND DECLARATION

  • I (We) have read and understood the Supplementary Regulations issued for this meeting and agree to be bound by them and by the National Competition Rules of the Australian Auto-Sport Alliance Pty. Ltd. (AASA);
  • I (We)acknowledge that motor sport is dangerous and that accidents causing death, bodily injury, disability and property damage, can, and do happen;
  • I (We)also acknowledge and agree that neither Australian Auto-Sport Alliance Pty. Ltd., nor sponsor organisations, nor land owners or lessees, nor organisers of the event or their respective servants, officials, representatives or agents (all of whom shall be collectively called “the organisers”), shall be under any liability for my death, or any bodily injury, loss or damage which may be sustained or incurred by me, as a result of participation in or being present at the event, except in regard to any rights I may have arising under the Trade Practices Act 1974.
  • I/We accept the conditions of, and acknowledge the ricks arising from, attending or participating in the event and being provided with the event services by AASA and the Associated Entities.

Entrants signature: ______Date: ______/ ______/ ______

Driver signature: ______Date: ______/ ______/ ______

Driver 2 signature:______Date: ______/ ______/ ______

Scrutineering Sheet & Disclaimer

Print this form on the back of your entry form

Event name: ______Driver name: ______

Vehicle make: ______Vehicle model: ______

Inspection Items / YES / NO
Competition Licence Type & Number(Official to sight)
Drivers Licence Number (Official to sight)
Club Member
Helmet to standard (as per supplementary regulations)
Battery firmly attached
Brake Master Cylinder fluid level correct
Minimal Engine oil leaks
Bonnet Secure
Minimal Steering Wheel free play
Brake pedal firm
Seat secure
Seat Belt in good condition
Wheels & Tyres road worthy
Loose objects removed
Tow hook points
All Lights work

By signing this form, I accept and understand that:

•Motoring activities are dangerous and accidents causing harm can and do happen;

•I acknowledge that I will probably be held accountable for any property damage that I cause;

•I am not under the influence of any drugs or alcohol;

•I do not have a medical condition that may affect my ability to drive a motor vehicle;

•I declare that I have read and understood the above conditions, supplementary regulations and rules for this event;

•I declare that I have scrutineered my car to meet the safety requirements as outlined above.

Driver’s signature: ______Date: ______

Official’s signature: ______

Form: MX5RACSE1Page 1 of 2