APPLICATION FORM

“Super-Veteran” Lublin meeting

May 20-22nd 2011, Lublin

Please send on-line this completed application form until the May 7th may 2011.

Participant

NAME / DATE OF BIRTH
SURNAME / ADDRESS
PHONE / CITY
E-MAIL / POSTAL CODE

Motorcycle

BRAND / MODEL
YEAR OF PRODUCTION / ENGINE TYPE [2 OR 4-STROKE]
CAPACITY [cm3] / ENGINE POWER [HP]
SIDECAR / YES/NO
REMARKS

Competitions 21th may 2011.

RACE / YES/NO
TRIAL / YES/NO
ELEGANCE CONTEST / YES/NO
REGULARITY TRIAL / YES/NO

Motorcycle rally attend

NUMBER OF PERSONS
SCHEDULED TIME OF ARRIVAL
SCHEDULED TIME OF DEPARTURE
MOTORCYCLE PARKING / YES/NO

ATTENTION! Organizer will not make a hotel reservation for You. Please book and pay hotel on Your own. Our recommendation for accommodation: Ośrodek Graf-Marina, ul. Krężnicka 6, 20-518 Lublin, which is the event location.

Apart from submitting the above on-line application form, please contact personally the Race Office on the day of race, 21st May 2011, since 8.00, before the race begins.

STATEMENT

I hereby state that I am acquainted with and obliged to observe the contents of the Regulation of the Race and the regulations concerning the ban to use anabolic steroids and substances mentioned in the regulation of the medical service of the motor competition. In relation to the acceptance of my application to participate in the race I am obliged not to institute any legal proceedings and any other claims against the organizers, official workers, representatives and agents to return costs and expanses or in case of my death and injuries received by me, irrespective of the fact it results from the application to participate in the race.

I hereby state that if I suffered from any permanent or temporary ailments which may imply on the way of automobile control at the moment of the race commencement, I would not participate in the competition and I would report this to the Race Office, which is confirmed by my signature.

I hereby state that in case of any accident or collision during the race or trainings included in the detailed regulation of the competition caused unintentionally or caused because of that accidents or collision any damages I am obliged not to sue or take legal actions against: GKSM PZM, Club, Competition organizers, Referees and their assistants, Participants of races and trainings, Organizer’s employees, Other people involved in organizing the competition.

I accept “Super-Veteran” Lublin regulations..

I hereby authorize Organizer to process my personal data included in my application form for the needs of the registration process (in accordance to the Personal Data Protection Act 29.08.1997 no 133 position 883).