APPLICATION & WAIVER

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This application form is used to apply to take part in the coaching video series Faster For Free by Dale Lomas. The data gathered here is ONLY for use by Dale Lomas, and will not be shared without your consent.

Email *

Contact Number (mobile) *

Full Name *

Date of Birth *

YYYY

Country of residence *

Vehicle (Make, Model, Year)

Which circuit will you be driving? *

Preferred date to film *

YYYY

Please let me know the dates you will be available to drive and film:

(Use DD/MM/YY and specify from and until if it's a range of days)

Participation, Risk, & Release *

I am participating voluntarily and at my own risk.

I understand this coaching may occur during trackdays, and/or other events on various circuits. I accept full responsibility for my vehicle, entry fees, and compliance with all organiser rules.

I have a valid driver’s license and appropriate liability insurance.

I understand all coaching is advisory and results are my responsibility.

I grant permission for my image, voice, vehicle, and footage to be used in any and all media on the afore-mentioned event..

I accept that public commentary on my driving may be included.

I consent to the processing of my data as required for participation and media use, in line with GDPR.

I confirm that I am over 18 years old and legally responsible for my actions during the session.

Required

Date *

YYYY

Signature *

Please type your FULL NAME to agree with all the conditions above

A copy of your responses will be emailed to the address you provided.

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