Queensland Raceways
Phone: 07 5461-9100 Fax: 07 5461 9111 ABN- 41 133 848405
Lakeside Classic Speed Fest
“Please PRINT neatly and fill in ALL information” Date: 19-20September 2009
Lakeside_Classic_Speed_Fest-QEMS.doc
Queensland Raceways
Phone: 07 5461-9100 Fax: 07 5461 9111 ABN- 41 133 848405
Vehicle Owner(s)…………………………………………….….……Dorian number………………..…Preferred Race No.:………………
Postal Address: ………….………………………..…………….…...... Town…….……….….………………Pcode:….……………...
Ph(Hm):……..………………. (Work/Mob):……..……..…………… Email Address: ……………………………………………………….
Vehicle Driver: ……………………………………………..………Civil Lic No.: ……….…….….….. Race Lic No.: .………..……………
Postal Address: ………….………………………..………...... Town………………..……………..…Pcode:….……………...
Emergency Contact:- Name………………..…………………...... Hm Ph …………………………..Mbl Ph .………………..…………
Make Of Car:…………..….. Model:…….……..…………Year:…………...Colour:………………..…….Capacity:…………..…cc’s
Category Entering (Please Circle) QEMS
Entries must be Received and Paid for, by Wednesday 9th September 2009. (Normal QR Passholder discount applies.)
Entry for Demonstration Racing / 100.00Annual AASA National Race Licence (If Approved) / 210.00
AASA National Single Event Licence (If Approved) / 60.00
Annual AASA Clubman Sprint Licence (used with CAMS Race Licence) / 55.00
AASA Clubman Single Event Sprint Licence (used with CAMS Race Licence) / 20.00
Payment Details: Please make cheques or money orders payable to QR Operations P/L.
Credit Card Payment: I hereby authorise Queensland Raceways to debit my Credit Card for the sum below:
MasterCard Visa AMEX
Card Holders Name______Card No ______Expiry Date: ___/___
Signature:______Receipt No. ______TOTAL / $ .00
WARNING OF RISKS Owner’s & Driver’s Declarations:
I acknowledge and agree motorsport is dangerous and that accidents can and will happen in which I can be injured or die.
I also acknowledge and agree as a condition of entry that the Promoters, nor the sponsor organisations, nor the land owners or lessees, nor the organisers of the race meeting/event, nor their respective servants, officials, representatives or agents shall be under any liability for my death, or any bodily injury, loss or damage to my property which may be sustained or incurred by me as a result of participation in or being present at the event.
I agree the Promoter has the right to terminate my participation in the event at any time for whatever reason it sees fit at the time.
I acknowledge that I have thoroughly inspected the Track and found it to be in safe condition for the activities I intend to undertake. By using of the Track I indicate my acceptance of the Track’s condition for the activity(s) I will undertake. If an act or occurrence in which I am involved or observe reduces the safety of the Track I will immediately notify the Promoter and warn other track users of the danger and/or increased risk.
Should any incident occur in a public area as a result of my failure to comply with the normal circuit rules or a direction given from an official whereby a successful claim is made under any insurance policy relating to the Track and an excess premium or deductible is charged by the insurer of the Track I will if required pay the excess or deductible under such insurance policy except to the extent that it is paid by a third party.
I declare that I agree to abide by the General Terms and conditions of Track Usage and the conditionsof this EntryForm,; have read and understood these warnings, and accept all the inherent risks and danger in the event and the activities surrounding the event.
______
Owners Statement: Driver Signature Owner Signature
I/We being the owners of the vehicle described in this entry form certify that the vehicle is track worthy, meets or exceeds the events requirement and meets all safety requirements. We further certify that the particulars on this form are true and correct in every particular, to the best of my/our knowledge and belief.
______
Owner’s Signature
For persons under the age of 18 years the following parent/guardian consent must be completed.
I ………………………………………………of [Address] …………………………………………………………………………………………………am the parent/ guardian*of the above-named ("the minor") who is under 18 years old. Ihave read this document and understand its contents, including the exclusion of liability and assumption of risk, and have explained the contents to the minor. I consent to the minor attending/ participating in the event at his/her own risk.
Signature of Parent / Guardian………………………………………………………. / Date…………………………………*MUST be an actual Parent or the Legally appointed Guardian - Delete whichever does not apply
Conditions of Entry Please Read Them Fully
If you are a competitor the ONLY acceptable blood/alcohol reading is 0.00. The management and promoter may test any competitor at any time. Any positive BAC reading is automatic exclusion from driving for the rest of the event.
Consumption of alcohol or use of any substance capable of impairing good judgement may only be consumed within the designated spectator areas. Consumption or use in ANY competition, officials, marshalling or support paddock area is strictly prohibited before or during any activity.
The management and promoters have the right to expel any person from Queensland Raceways that they consider to be acting in a manner which is dangerous or impedes other peoples’ ability to enjoy the activities or causes them to bring a complaint to the management or promoters.
Clothing for drivers and crew must be appropriate for the activity of motorsport. This means crew/team membersmust wear enclosed footwear with full coverage from ankle to wrist to neck when working on the vehicle or in pit lane. Drivers require a one piece driving suit made from flame proof material. Entrant’s apparel and work practices are subject to Occupational Health and Safety legislation when performing work and tasks at Queensland Raceway.
Drivers must wear helmets during any competition. Helmets must meet at least the AS1698 requirements.
Official’s directions must be followed promptly and with full compliance. Officials are volunteers giving their time so you can enjoy your chosen activity and shall be treated with due respect. Any driver or crew that has a problem with a direction from an Official shall meet the Official’s request and then raise the issue with the management or the promoter.
Vehicles must be driven SLOWLY at all times and in ALL AREAS until they are actually competing or participating in an event. MAX SPEED IN PIT LANE IS 40kph and 10kph IN ALL PUBLIC AREAS. Drivers exceeding these limits should expect to be at least cautioned or not permitted to participate in further runs and potentially to be expelled from Queensland Raceways.
Scrutineering and Vehicle preparation requires the vehicle to be adequately prepared for the event. This includes steering and brakes, especially pads and fluid and all safety equipment especially seat belts & roll over protection shall be in excellent working order.
Fire extinguishers, when fitted, must be secured in the passenger side foot well within reach of the driver with quick release fittings capable of holding the bottle in place at 20G.
Drivers must hold a Civil Licence and a AASA Competition Licence that is appropriate to the level of the event being undertaken.
Competitors should note no persons under the age of 12 are permitted inside the Pit Lane unless accompanied by an adult.
No animals are permitted in the grounds of Queensland Raceways during an event unless they are part of the event and have written permission from the management to be on the premises.
Closing time for entries is the latest time an entry can be received and processed before closing on the Friday before the race meeting at the Queensland Raceway office.
There are no fines BUT people who behave dangerously are sent home. People who behave dangerously a second time are sent home and have to miss the next meeting as well. People who behave dangerously a third time don’t get invited to race with us again.
NO unregistered scooters, pit bikes etc. are to be ridden in the Paddock Area. The Police can fine people for not having a licence or wearing a crash helmet even though it is private property. We suggest its best to leave the bikes at home and let the kids get some exercise.
REFUND POLICY………
PLEASE NOTE: Refunds will be given according to the following
Withdrawal 7 days prior to event- 100% refund or credit for future event
Withdrawal up to 8.00am the Friday before event- 50% refund or 100% credit
Withdrawal after 8.00am on the Friday before the event- NO refund or credit
FIRST & LAST RULE:
I will help to keep the event safe, sensible, smart and satisfying for EVERYONE – not just ME.
Lakeside_Classic_Speed_Fest-QEMS.doc