FOREST EDGE KART CLUB LTD

RACE DAY – ENTRY FORM 2015

Circle the meetings you wish to enter and send the entry form and your fee to the Competition Secretary at the address detailed over.

NOTE: the appropriate fee must be received by the Competition Secretary one week prior to the meeting; otherwise the entry will be void

DATE;-

Junior / Senior / Class / Preferred Race No.
Name
Address
Tel No.
Novice
Yes / No
Circle 1 option / PLG Number.
Must be completed / Licence No.
Must be completed / Transponder No.
Must be completed / Club
Must be completed
Kart Chassis / Engine
Contact in case of Serious Accident
Address
Telephone

Acknowledgement by S.A.E or. EMAIL…………………………………………………………………………………………….

OFFICE USE ONLY / Date entered / Cheque/Cash / Fee paid

PLEASE SEND ALL ENTRIES TO, Carole Parsons, 29 Alexander StreetBlandford Dorset DT11 7JG (Enclose an S.A.E. or email address if acknowledgement required) Telephone 01258 451097

THIS EVENT IS HELD UNDER THE GENERAL REGULATIONS OF THE MOTOR SPORTS ASSOCIATION LTD. (INCORPORATING THE PROVISIONS OF THE

INTERNATIONAL SPORTINGCODE OF THE FIA) AND THE SUPPLEMENTARY REGULATIONS.

(A)I have read the supplementary regulations issue for this event and agree to be bound by them and by the general regulations of the Motor Sports Association Ltd. In consideration of the acceptance of this entry or of my being permitted to take part in this event, in respect of any parts of the event not held on a publicly adopted road, I agree to have harmless and keep indemnified the MSA Ltd, such Persons, Persons or Body as may be authorised by the MSA Ltd. To promote or organise this event and their respective Officials, Servants, Representatives and Agents from and against all actions, claims costs, expenses and demands in respect of Death of r Injury to or Damage to the Property or myself, my Driver(s), Passenger(s) or Mechanic(s) or associated personnel, arising out of or in connection with this entry or my taking part in this event.

MY AGE IS ……………………………………………………. (State if under 18 years)

(B)I declare that to the best of my belief the driver/s possess/es the standard of competence necessary for an event of the type to which this entry relates and the vehicle entered is suitable and roadworthy for the event having regard to the course and the speeds that will be reached.

(C)I Understand that should I at the time of this entry be suffering from any disability whether permanent, temporary or otherwise which is likely to affect prejudicially my normal control of my vehicle, I may not take part unless I declared such disability to the ASN, which has following such declaration, issued a license which permits me to do so.

(D)I undertake that at the time of the event to which the entry relates I shall have passed an ASN specified medical examination within the specified period.

SIGNATURE OF DRIVER…………………………………………………………..

(Any entry which is signed by a person under 18 years of age must be countersigned by that person’s parent, guardian or guarantor whose full name and address must also be given). If the parent or guardian is not at the meeting with under 18 drivers, will you make sure that the persons running the driver has your written authority to act on your behalf.

PARENT/LEGAL GUARDIAN/GUARANTOR’S DECLARATION

As the Parent/Legal Guardian/Guarantor “I confirm that I have acquainted myself with the MSA General Regulations, agree to pay any appropriate charges and fees pursuant to those Regulations (to include and appendices thereto), and hereby agree to be bound by those regulations (and ant subsequent alterations therefor). Further I agree to pay as liquidated damages any fines imposed upon me to the maxim set out in Appendix 3 part 13.

I hereby agree to abide by the MSA Child Protection policy and Guidelines.

COUNTER SIGNATURE……………………………………………………………

NAME & ADDRESS……………………………………………………………………………………

…………………………………………………………………………………………………………..

POSTAL ENTRIES CLOSE ON SATURDAY 6PM ONE WEEK PRIOR TO THE MEETING

ONLINE ENTRIES CLOSE MIDNIGHT ON TUESDAY PRIOR TO THE MEETING

All LATE entries will be surcharged £15.00

LATE ENTRIES ARRIVING WITHOUT THE SURCHARGED FEE WILL NOT BE ACCEPTED.

Race entry fees;NON-MEMBERS£55.00

MEMBERS£40.00

Note: There will be a charge of £8.00 for any cheque returned for any reason