Entry Form SCC Kempton Solo – Sunday 27th October 2019
Southern Car Club Limited (SCC) will promote a Clubman's Permit AutoSolo event on Sunday 27th October, at Kempton Park Racecourse, Sunbury on Thames, Middlesex TW16 5AQ.

The event will be governed by the 2019 General Regulations of Motorsport UK (incorporating the provisions of the FIA’s International Sporting Code), these Supplementary Regulations and any written instructions that the Organising Club may issue for the event

The entry fee is £48 per driver or £15 for drivers under 21. Entries received after Friday 18th October 2019 must add £5.

Southern Car Club members that are under 25, but over 21, will have a 25% discount applied and their entry fee is £36 - with thanks to the Brian Hugh Fund.

SCC members under 25 get 25% off joining fees, club fees, event fees* and social events. Membership forms are available on the SCC website.

Eligibility:
a) Members of SCC, CSMA, Bournemouth & DCC, Southsea MC, Dolphin MC, Falcon MC, Oxford MC, Basingstoke MC, Sutton & Cheam MC,Farnborough District Motor Club, Goodwood Road Racing Club, BTRDA and members of clubs in the AEMC, ACSMC and ASEMC.
b) Registered contenders for the 2019 ACSMC AutoSolo Championship
c) The event is the second round of the 2019 FDMC Solo Challenge

All drivers must produce a valid club membership card.

Event Regulations are published here: http://southerncarclub.com/wp-content/uploads/2019/08/Regulations-SCC-Kempton-October-Solo-2019.pdf

Email addresses are required so you receive a copy of your entry form and so we can send final instructions and results.

On entering this event you agree that we may wish to publicise your personal data as part of the results of the event. We may pass such information to Motorsport UK, national governing body and/or the FIA or any affiliated organisation for the purpose of insurance, safety, licences or combined with other events. Results include (but are not limited to) name, club affiliation, competition times, occupation and age category.

As we are collecting your personal information we must draw attention to our Privacy Policy here:
http://southerncarclub.com/wp-content/uploads/2018/05/SCC-Privacy-Notice-20180525.pdf

Email address *
DRIVER DETAILS
Full Name *
Your answer
Full Postal Address with Post Code *
Your answer
Telephone Number *
Your answer
Date of Birth if under 17 or SCC member under 25, else ignore.
MM
/
DD
/
YYYY
Do you hold a current RTA (Driving) Licence?
PASSENGER (only for drivers with no RTA licence)
Passenger Name
Your answer
Passenger Age
MM
/
DD
/
YYYY
Passenger Experience or N/A
Is passenger Experienced in Autotest or Autosolo?
CLUB DETAILS
You will need to show a valid Club Membership card at event registration.
Club (please contact the secretary if your club is not invited): *
You must be a Member of an Motorsport UK recognised Club. Re-read the regulations if you need to join a club, or contact Southern Car Club Membership Secretary to join quickly. Details on our website http://southerncarclub.com/?page_id=1471
Your answer
Please indicate if you are an ACSMC championship contender: *
EMERGENCY CONTACT DETAILS - DRIVER
Name & Relationship *
Your answer
Address & Telephone *
Your answer
EMERGENCY CONTACT DETAILS - PASSENGER
Name & Relationship
Your answer
Address & Telephone
Your answer
DOUBLE DRIVE
! Each driver must complete a separate entry form.
Do you have another driver if sharing car (Double Drive)
CAR DETAILS
Make *
Your answer
Model *
Your answer
Registration Number *
Your answer
CCs *
Cubic capacity e.g. "1598" , just enter the numeric digits
Your answer
Fuel *
Forced Induction (Turbo or Supercharged) *
Class *
You are confirming that your car is eligible for this class. See notes in Regs.
PAYMENT DETAILS
PayPal - Online Payment via "Buy Now" button from Event Entry Page http://southerncarclub.com/?page_id=7912#paynow. You can use PayPal with a Credit or Debit card and you do not need a PayPal account.

Cheques - Payable to "Southern Car Club"
Sent to: Entries Secretary, 39 Regent Court, Norn Hill, Basingstoke, RG21 4HP
Payment Method
DECLARATION of INDEMNITY
INDEMNIFICATION DECLARATION (see below) The indemnification as per GR D.13 will also be included in the Signing-On sheet which all competitors must sign on arrival at the event, as per GR H33.1.1. If the Entrant/Driver will be under the age of 18 on the day of the event, his or her parent or guardian must complete the parental consent form, this can be downloaded from the Motorsport UK website https://www.motorsportuk.org/assets/parentalconsentauthorisation.pdf

DECLARATION I declare that I have been given the opportunity to read the General Regulations of the Motorsports UK see www.motorsportsuk.co.uk and 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 the type of competition and the potential risk inherent with motorsport and agree to accept that risk. Further, I understand that all persons having any connection with the promotion and/or organisation of the event are insured against loss or injury caused through their negligence.
Age if under 18 years otherwise state "Over 17 years" *
Your answer
Please read the Declaration Page from the Entry Regulations *
Required
PARENTAL CONSENT
If the Entrant/Driver will be under the age of 18 on the day of the event, his or her parent or guardian must complete the parental consent form, this can be downloaded from the Motorsport UK website https://www.motorsportuk.org/assets/parentalconsentauthorisation.pdf

NOTE: If Driver is under 18 years of age, please read Motorsport UK Blue Book relevant sections.
The following MUST be completed by that person’s Parent or Guardian. They must also either endorse the signing-on form on the day or supply a letter stating that the Parent/Guardian knows what is going on and relates to the event and date.
Parent or Guardian of:
Your answer
Parent or Guardian Name & Relationship to Competitor
Your answer
Parent or Guardian Address & Telephone Number
Your answer
END OF FORM
Permission to Contact You *
Southern Car Club is an organisation run by volunteers for motorsport enthusiasts. To support our sport we would like to be able to contact you about future events. We require your permission to contact you and would appreciate it if you can answer "yes" below.
A copy of your responses will be emailed to the address you provided.
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