AMCA Winter Champ

SCTC at Hermitage Farm

Sunday 9th March 2014

Venue; Hermitage Farm, Froghall ST10 2QH

Directions Signed off A52

Start 11am

Classes Expert / Clubman / Non Expert / Twin Shock A/Twin Shock B

Entry Fee AMCA licence Holders £8 post £15 day

Guest £10 post £15 day

Entries to Mr J Bottrill 28 Emmanuel Road Burntwood Staffs WS7 9AD

Tel 01543 684967 or Mobile 0754653423 Email This email address is being protected from spambots. You need JavaScript enabled to view it.

Cheques Payable SCTC

Christian Name........................................................Surname..........................................

Address..............................................................................................................................................................................................................................................................................................................................E-Mail.............................................

Tel........................................................................AMCA Licence..................................

Club......................................................................Machine...........................................

Grade

: Expert / Clubman / Non Expert / T Shock A (Club R)/ T Shock B (N/E R)Pre 65 A/Pre 65B

Also tick if guest

INDEMNITY

HELMETS TO BE WORN AS PER AMCA RULES

Declaration: Motor Sport can be dangerous and may involve injury or death. You must read and agree to the following declaration and paragraphs below which are designed to create a legally binding relationship in return for you being allowed to enter and compete.

1 I confirm that the information in this entry form and the information and my acceptance of the terms of my competition licence are correct

2 I confirm that I that I understand the nature of the competition I am entering and I am competent to take part.

3 I confirm that any vehicle I use will comply with the regulations and will be safe and fit for use in the competition

4 Before taking part in the event I will ensure ( Unless prohibited ) that I have inspected the venue, the track and the facilities and geographical features and that I am satisfied that it is safe for me to compete.

5 I will not take part if I have any doubt about my ability or the safety of the venue.

6 I accept that the competition in motor sport may involve the risk of injury or death and agree to take part at my own risk.

7 Before taking part in the event I will read and be bound by and comply with general regulations, any supplements and final instructions issued by the AMCA, the organisers and the circuit owners and the regulatory body

8 I will not participate whilst under the influence of alcohol or intoxicating drugs and that if I am taking any prescribed medication I will inform the event organiser and seek approval to participate before taking part.

9 If under the age of 18, my parent / guardian has read the above and signed the declaration below.

Entrants Signature.........................................................................................................Date..........................................................

Please complete box below for entrant under 18 years

Parent / Guardian Declaration and Agreement To allow the applicant to enter the competition you must agree to the matters set out below which are designed to create legal obligation on you Sign below only if you agree

I

............................................(Print Name) am parent / legal guardian of .............................................

a) I have read the entry form and declaration completed by the applicant and confirm the answers are true

b) I confirm that he/she is competent to take part in the event and that any vehicle which he/she will use is safe and fit for the competition

c) I will, before allowing him/she to take part, satisfy myself that the course and facilities are safe and will inspect same.

d) I also hereby AGREE that if the applicant should sustain any injury from any cause whilst taking part in the event and as a result bring claim for compensation against you or the organisers or officials or sponsors or entrants or owners of the venue

I WILL INDEMNIFY AND PAY BACK TO YOU any sum which you may be required to pay as a result of such claim.

Signature of Parent /Guardian

........................................................Date ........................................

Address (if different from applicant

)..............................................................................................