Event / Beginner /Intermediate Karting 2016
Date of event / From May to October 2016
Closing date for entries / 2 weeks prior to the date of the event

Please complete all sections in BLOCK CAPITALS. CSSC membership numbers must be included. You may find it helpful to ‘Tab’ from one field to another.

Section 1: Your Details (Delete as applicable)

Mr/Mrs/Miss/Ms/Other / Forename: / Surname:
Male/Female / Date of birth:
Address
Postcode
CSSC membership no.
Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.
NoK Address
NoK Postcode

Section 2: Venues and dates

It would help us if you could indicate which events you will be entering in advance and then confirm with payment 3 weeks before the event. :

Venue / Date / Closing Date / Arrive/
Start
Time / Member
Price / Non-Member
Price / Entry
(please
tick)
Teesside
South Tees
Motorsports Park
Dormor Way
Middlesbrough
TS6 6XH / Sunday 22nd
May 2016 / Friday 6th
May 2016 / 10:30am
for
11:00am / £30 / £50
Daytona Sandown Park
More Lane
Esher
Surrey
KT10 8AN / Saturday 16th
July 2016 / Thursday 30th
June 2016 / 10am for
10:30am / £35 / £60
Karting North East
Warden Law Motorsports Centre
Sunderland
Tyne & Wear
SR3 2PR / Saturday 30th
July 2016 / Friday 15th
July 2016 / 11:30am
for
12pm / £35 / £60
Daytona Milton Keynes
Rooksley
Dansteed Way
Milton Keynes
MK13 8NP / Sunday 25th
September 2016 / Friday 9th
September 2016 / 9am for
9:30am / £35 / £60
Daytona Tamworth
Robeys Lane
Tamworth
B78 1AR / Saturday 29th
October 2016 / Friday 14th
October 2016 / 10am for
10:30am / £35 / £60

Section 3: Cost

Please see the above chart for pricing.

Payment can be made for each individual event entered. All payments must be received before the closing date.

Payment can be made by debit/credit card – please ring Rebecca Brand on 01494 888407 with details

Cheques should be made payable to ‘CSSC Ltd’.

WITHDRAWALS:

No refund will be given after the closing date of each competition. Written confirmation to Rebecca Brand must be given of any withdrawals (email is acceptable). If the event is cancelled by CSSC then a refund will be given by the Head Office Treasurer.

Section 4: Medical and Dietary Requirements

Medical: please let us know if you have any physical or medical conditions. / Yes No
If yes, please give details

Section 3: National Subsidy for travel and subsistence

All CSSC Regions have signed up to provide competitors with financial help to attend CSSC National Open Events, please click here to see what you are entitled to claim or email the CSSC Events team on

Costs for use of a private car are assessed on the basis of mileage and fuel type and will be as follows:

·  Driver - 50% of mileage costs up to one times the current full annual CSSC subscription;

·  Passengers – 5p per mile up to a maximum of £15 per passenger.

·  Costs for use of public transport will be 50% of costs up to one times the current full annual CSSC subscription;

If overnight accommodation is booked centrally by CSSC HO then CSSC will provide the cost figure to be assumed for rebate purposes. If you book your own accommodation then that is the cost for claim purposes but if you book your own accommodation independently of a CSSC offering then that must be justified. Costs will be as follows:

·  For each night only 50% of the cost up to a maximum of the current full annual CSSC subscription; subject to a maximum claim for any one event of two times the current full annual CSSC subscription.

IMPORTANT: These events are active and participants should be aware of the physical activities involved. CSSC reserves the right to cancel the event if under subscribed.

All CSSC members taking part in the event are covered by CSSC Sports and Leisure Public Liability Insurance. Please note that this policy is NOT a Personal Accident Policy. Members are encouraged to take out their own insurance policy.

Signed: Date:

If you require any further information concerning the events please

Dave Mappin –

Please send all entries to Rebecca in the Event Team at Head Office either by post or email.

Rebecca Brand

Event Team

Compton Court,

20-24 Temple End

High Wycombe,

Bucks,

HP13 5HW

E-mail:

Tel: 01494 888407