Permit No.

ACU42954

SOUTH SHROPSHIRE MCC

THE VIC BRITTAIN TROPHY TRIAL

The club will hold a open Midland Centre Championship trial on 25th January 2015

Please note: this event will be an on road trial.

Officials of the meeting:

MIDLAND CENTRE

ACU APPROVED

REGULATIONS

Clerk of the course

John Wells/Jim Teague

Lic.
#: 6586/47057

Club
Steward

Steve
Fox

Secretary
of the meeting

Jim Teague

43
Lea Vale Road, Norton, Stourbridge. DY8 2AT

07917475837

Point of contact for N/A

The
club will hold an Open to Centre trial for solo machines only. To be held under
the National Sporting Code rules of the ACU, the Standing Regulations for
trials, these supplementary regulations and any final instructions which may be
issued up until the start of the trial.

Entry fees: £18.00. Cheques
payable to South Shropshire MCC. May include 2 x SAE but all information will
be available on the club website. Entries will close on the 17th
January 2015. No late entries.

Venue and Start Time: The Coates Farm,
East Wood, Longville in the Dale, Shropshire. 1st rider away at 9:30am, the
rest at one minute intervals. The method of marking for this trial will be
TSR22B. Petrol is not available at the start.

Course: The trial will be of
a sporting nature and will have 2 routes, and will include a 50-50 route, half
the sections from the 'A' route and half the sections from the 'B' route.

Note: Events run
as open trials.
Any affiliated member of an ACU club can enter the trial.

____________________________________________________________________________________________________

South
Shropshire MCC

The Vic Brittain Trophy Trial

25.01.2015

Rider
No.

Surname:___________________________________First
Name:______________________________________________________

Address:____________________________________________________________________________________________________

___________________________________Post
Code:________________________Phone No:________________________

ACU Club: ________________________________________________________Date
of Birth if under 18:________________________

ACU
Affiliated
Number:______________________________Machine___________________________________Capacity________

Please
tick class entered:- Expert ___ Intermediate ___ Master ___ Clubman ___ Over 40
___

NB.
Experts & Intermediates will ride the hard route, Masters the 50/50 route
and Clubmen & Over 40 the easier route

Entry
declaration:
I / we the
undersigned apply to enter the event described above and in consideration
thereof: -

·
I / we hereby declare that I / we have
had the opportunity to read, and that I / we understand the National Sporting
Code of the ACU, the ACU Standing Regulations, such Supplementary Regulations
as have or may be issued for the event, and agree to be bound by them.

·
I / we further declare that I am / we
are physically and mentally fit to take part in the event and I am / we are
competent to do so.

·
I / we confirm that I / we understand
the nature and type of event we are entering and its inherent risks and agree
to accept the same notwithstanding that such risks may involve negligence on
the part of the organisers or officials.

·
I / we confirm that the machine(s) as
described below which I / we compete on shall be suitable and proper for the
purpose.

·
I/we confirm that I/we are eligible to
compete on the machines for which I/we have entered.

·
I / we confirm that if any part of the
event takes place on a public highway, the machine(s) described below shall be
insured as required by the Road Traffic Acts, or equivalent legislation, and
that it / they will comply with the regulations in respect thereof.

·
I / we agree that I am / we are
required to register our arrival by "signing on" at the designated place prior
to commencement of my/our practice or first competition, whichever occurs
first.

I/we
confirm that I/we are not suspended or my/our ACU Licence has not been
suspended/withdrawn from any ACU competition.

·
I/we enclose the entry fee of: £18.00

Acknowledgement of the risks of motor sport:
I/we understand that by taking part in this event I/we are exposed to a risk of
death, becoming permanently disabled or suffering some other serious injury and
I/we acknowledge that even in the event
that negligence on the part of the ACU, the promoter, the organising
club, the venue owner, or any individual carrying out duties on their behalf
were to be a contributory cause of any serious injury I/we may suffer, the
dominant cause of any serious injury will always be my/our voluntary decision
to take part in a high risk activity.

I/we have read the above and acknowledge that
my/our participation in motorsport is entirely at my/our own risk.

Rider's signature:
___________________________ If
under 18 state date of birth*:
DOB___________________________

* For riders under 18 years of age – I
accept the above conditions of entry to this event and give my approval:-

Signature
of parent or person with parental responsibility:
_________________________________________

Riders under 18 years of age who cannot produce a
valid ACU Competition Licence/Trials Registration must also complete a
'Parental Agreement form (single event)' in addition to this entry form.