WINTON HISTORIC FESTIVAL OF SPEED

13th14thAugust 2011 Entry Form

Promoted by the Victorian Historic Racing Register. Inc and Winton Motor Raceway

Held under the National Competition Rules of Australian Auto – Sport Alliance Pty Ltd. Entrants should indicate hereunder the category of events for which they desire to nominate. The organisers reserve the right to enter cars in events deemed appropriate subject to not being in conflict with the National rules. AASA Permit No.:AASA150811/WFS279

TAX INVOICE. ABN: 97 521 303 894

Entries open Monday 23rdMay 2011 and close Friday 8thJuly 2011

Sa / Na / F5000 / F Ford Fa / Group J & K / M. Sports
Sb / Nb / Q & R Racing / F Ford Fb / Lb Racing / M. Racing
Sc / Nc / Q & R Sports Cars / F Ford Fc / Lb Sports / O Sports
Gr N Endurance race 20 laps (no extra cost) / Div 1 Regularity & Invited cars / Div 2 Regularity & Invited Cars / Formula Vee / O Racing

Sponsor

Competitor (Car owner)

/ Competition Licence No.

Driver

/ Competition Licence No.

Address

Post Code /

Ph

Wk
Mob
Driver’s Date of Birth / /

Make of Car

/

Model

/

Passport/Log Book No.

Year of Car

/

Capacity cc

/

Colour

/

Dorian No

Car club

/

Preferred No

E-mail Address

/

FAX #

Pit crew 1. / 2. / 3.
4. / 5. / 6.

Please read and sign the disclaimers on the reverse side. This entry is not valid if these disclaimers are not signed.

Fees / Cheque / Card (+3%) / Write in amount
Entry Fee / $295.00 / $ 303.00 / $
Cross Entry / $150.00 / $ 154.50 / $
Same driver 2nd car / $150.00 / $ 154.50 / $
Commemorative Cap 25% disc / $ 15.00 / $ 15.00 / $
$
Total including GST / $


WINTON HISTORIC FESTIVAL OF SPEED

13th14thAugust 2011

DISCLAIMER EXCLUSION OF LIABILITY, RELEASE AND ASSUMPTION OF RISK

ENTRANTS AND/OR DRIVERS

ENTRANTS DISCLAIMER/DECLARATION

I/We………………………………..…of…………………………………………………………………………….…………….being the entrant/s of the vehicle described on this entry form wish to enter that vehicle for the above mentioned meeting. I/We declare that the particulars on this form are true and correct in every particular, to the best of my/our knowledge and belief

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

* * * * *

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 know 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 Winton Motor Raceway Pty. Ltd., nor the sponsor organizations, nor the land owners or lessees, nor the organizers of the race meeting/event, nor their respective servants, officials, representatives or agents (all of whom shall collectively be 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.

I/We acknowledge that motorsport is dangerous and accidents causing death, bodily injury, disability and property damage can, and do, happen.

I/We accept the conditions of, and acknowledge the risks arising from, attending or participating in the event and being provided with the event services by AASA and the Associated Entities.

.

Competitor’s (Entrant's) signature: / Date:
Driver’s signature: / Date:

For persons under the age of 18 years the following parent/guardian consent must be completed.

.

PARENT/GUARDIAN CONSENT FOR ENTRANTS AND COMPETITORS UNDER 18 YEARS

I …………………………………………………………………………….being the parent/legal guardian of

………………………………………………………………..…… (please name), have read the whole of this document and consent to him/her participating. In doing so, I acknowledge that Motor Sport is dangerous, and agree that neither Australian Auto-Sport Alliance Pty. Ltd. nor “the organizers” shall be under any liability whatsoever for any death or bodily injury, loss or damage which may be sustained or incurred by the above named minor, or by me, howsoever such death or bodily injury, loss or damage is caused by negligence or otherwise.

Signed………………………………………
Parent/Guardian* / Date………………………………………
  • Delete whichever does not apply