Online Entry Form
Saturday 18th & Sunday 19th June 2011 – Mallory Park Circuit, Nr Hinckley, Leics.

Postcode:

Email Address:

Telephone:

1. I declare 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 motorsport and agree to accept that risk. Further I understand that all persons having any connection with the promotion and / or organisation and /or conduct of the event are insured against loss or injury caused through their negligence.

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 speed which will be reached.

3. 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, who have, following such declaration issued a licence which permits me to do so.

4. 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 / guardian / guarantor whose full names and address have been given.

5. If I am the parent / guardian / guarantor of the driver I understand that I have the right to be present during any procedure carried out under the Supplementary Regulations issued for this event and the General Regulations of the MSA.

I have read and accept the above declaration.

Postcode:

Email Address:

Telephone:

1. I declare 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 motorsport and agree to accept that risk. Further I understand that all persons having any connection with the promotion and / or organisation and /or conduct of the event are insured against loss or injury caused through their negligence.

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 speed which will be reached.

3. 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, who have, following such declaration issued a licence which permits me to do so.

4. 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 / guardian / guarantor whose full names and address have been given.

5. If I am the parent / guardian / guarantor of the driver I understand that I have the right to be present during any procedure carried out under the Supplementary Regulations issued for this event and the General Regulations of the MSA.

I have read and accept the above declaration.

Name:

Telephone:

Relationship:

Enter the code shown above in the box below.