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FDMC SEPTEMBER SOLO - ENTRY FORM - 23rd September 2018

Held under the General Regulations of the MSA Ltd (incorporating the provisions of the International Sporting Code of the FIA) and the Supplementary Regulations (please read carefully)

THE ENTRY IS FILLING FAST - PLEASE ENTER BUT DO NOT PAY UNTIL YOUR ENRY IS CONFIRMED

CLOSING DATE - END OF TUESDAY 18th September or when the entry limit is reached (then a reserve list will be added)
Thereafter, telephone the Entry Secretary.

Driver *
Your answer
Full Postal Address with Post Code *
Your answer
Telephone Number *
Please include the mobile number you will use on the day of the event - this allows us to send you times to your phone
Your answer
Passenger
Only allowed for drivers with no RTA licence
Your answer
Full Postal Address with Post Code & Telephone Number (passenger)
Your answer
email *
For Entry confirmation, Final Instructions & Results
Your answer
Age of Driver *
Drivers under the age of 18 will need parental/guardian consent - a form will be sent by the secretary
Club *
If your club is not invited (see regulations) contact the secretary
Your answer
Championship Contenders *
Are you registered for the 2018 ACSMC AutoSolo Championship
Emergency Contact Details Driver *
Please give the Name, Relationship, Address & Telephone number of someone to contact in the event of an emergency
Your answer
Emergency Contact Details Passenger
Please give the Name, Relationship, Address & Telephone number of someone to contact in the event of an emergency
Your answer
Car Sharing *
Please give the name of another driver sharing the car with you - state NONE if not sharing
Your answer
Car Make/Model *
Please give the cars make and model as shown in the vehicle log book
Your answer
Car Registration Number *
Please give the correct registration number of the car entered.
Your answer
Engine Size *
Please give the correct engine size in CCs.
Your answer
Engine Type *
Please tick as appropriate for your car
Required
Class Entered *
Please tick as appropriate for your car
Required
Payment Details *
Paypal - Online Payment via "PAY-NOW" button from Event Entry Page - You can use Paypal with a Credit or Debit card and you do not need a PayPal account. - Cheques; Payable to "Farnborough District Motor Club"
DECLARATION of INDEMNITY - Please read the Declaration shown below *
D13.1: I declare that I have been given the opportunity to read the General Regulations of the Motor Sports Association and, if any, the Supplementary Regulations for this event and agree to be bound by them. I declare that I am physically and mentally fit to take part in the event and I am competent to do so. I acknowledge that I understand the nature and type of the competition and the potential risk inherent with motor sport and agree to accept that risk.’I understand that motorsport can be dangerous and accidents causing death, injury, disability and property damage can and do happen. I understand that these risks may give rise to my suffering personal injury or other loss and I acknowledge and accept these risks. In consideration of the acceptance of this entry I agree that neither any one of or any combination of the MSA and its associated clubs, the organisers, the track owners or other occupiers, the promoters and their respective officers, servants, representatives and agents (the “Parties”) shall have any liability for loss or damage which may be sustained or incurred by me as a result of participation in the Event including but not limited to damage to property, economic loss, consequential loss or financial loss howsoever caused. Nothing in this clause is intended to or shall be deemed to exclude or limit liability for death or personal injury. To the fullest extent permitted by law I agree to indemnify and hold harmless each of the Parties in respect of any loss or damage whatsoever and howsoever arising from my participation in this event.’ 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 that the vehicle entered is suitable and roadworthy for the event having regard to the course and the speeds which will be reached'.D13.1.1 (b): I declare that the use of the vehicle hereby entered will be covered by insurance as required by the law which is valid for such part of this event as shall take part on roads as defined by the law.I understand that my personal data is being processed solely for the purposes of running this event and will be handled by the organisers in accordance with the MSA data protection policy which can be found at www.msauk.org/dataprotection. My age is: .................................................. (If applicable state “Over 17 years”)D13.1.4: I have read and fully understood the Procedure for Control of Drugs and Alcohol as contained in the Competitors’ and Officials’ Yearbook RegulationsH39, D35.1, G15.1.4 and have also fully familiarised myself with the information on the web sites referred to (www.ukad.org.uk & www.wada-ama.org ) in particular the UK Anti Doping Rules which have been adopted by the MSA. Further, if I am counter-signing as the Parent or Guardian of a minor then in addition to the deemed consent to the testing of that minor (UKAD Code Art 5.6.2) I hereby confirm that I give such consent for the minor concerned to be so tested.D13.1.5: I hereby agree to abide by the MSA Safeguarding Policy and Guidelines and the National Sporting Code of Conduct.I declare that my car complies with the vehicle regulations appropriate to its class.
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