FDMC SUMMER SOLO - ENTRY FORM - 9th JULY 2017

PLEASE NOTE ENTRY TO THIS EVENT IS NOW CLOSED - ANY QUESTIONS PLEASE CONTACT THE EVENT SECRETARY: PETER MANNING 01442874256

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)

CLOSING DATE - END OF TUESDAY 4th July 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 & Telephone Number
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 2017 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
Declaration: I declare that: 1) I have been given an 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 and competent to take part in the event. I understand that motorsport is 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. 2) 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. 3) The use of the vehicle hereby entered is covered by insurance as required by the law which is valid for such part of this event as shall take place on roads as defined by the law. 4) I understand that should I at the time of this event be suffering from any disability whether permanent or temporary which is likely to affect prejudicially my normal control of the vehicle, I may not take part unless I have declared such disability to the ASN which has, following such declaration, issued a licence which permits me to do so. 5) Any application form for a Licence which was signed by a person under the age of 18 years was countersigned by that person’s parent/legal guardian/guarantor, whose full names and addresses have been given. 6) If I am the Parent/Guardian/Guarantor of the driver I understand that I shall have the right to be present during any procedure being carried out under the Supplementary Regulations issued for this event and the General Regulations of the MSA. As the Parent/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 any appendices thereto) and hereby agree to be bound by those Regulations and submit myself without reserve to the consequences resulting from those Regulations (and any subsequent alteration thereof). Further, I agree to pay as liquidated damages any fines imposed upon me up to the maxima set out in Part 3, Appendix 1. Note: Where the Parent/Guardian/Guarantor is not present there must be a representative who must produce a written and signed authorisation to so act from the Parent/Guardian/Guarantor as appropriate. 7) I hereby agree to abide by the MSA Child Safeguarding Policy and Guidelines and the National Sporting Code of Conduct. 8) I undertake that at the time of the event to which this entry relates I shall have passed or am exempt from an ASN specified medical examination within the specified period. (H10.1.6) 9) I have read and fully understood the Procedure for Control of Drugs and Alcohol as contained in the MSA Yearbook Regulations H39, D35.1, G15.1.4 and have also fully familiarised myself with the information on the web sites referred to (www.ukad.org.uk and 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 (Art 5.6.2) I hereby confirm that I give such consent for the minor concerned to be so tested. Indemnity: 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 land 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 this event. 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.
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