Walsall Motor Cycle Club Ltd
Summer Championship Trial
Saturday 22nd August 2015
Hobs Hole Lane
Ven
ue Hobs Hole Lane, Aldridge
Directions Signed off A452 Chester
Road
Nearest Post Code: WS9 0LR
Start 4-00pm
Classes Expert / Clubman / Non-expert / Beginner / Tshock A / Tshock
B / Pre65
Entry Fee AMCA licence holders £10 Guest £12
Entries to
Liz Bolton, 01922 682607
Cheques payable to Walsall MCC Ltd
E-m
ail This email address is
being protected from spambots. You need JavaScript enabled to view it.
Walsall Motor Cycle Club Ltd Saturday
22nd August 2015
Christian Name ......................................
.......Surname..........................................
Address......
...........................................................................
.............................
........................................
...........................................................................
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.............................................................
....Tel..............................................................
email......................................................................
.........................................
AMCA Licence No ............
..............................club.........................................
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Machine ...................................................
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Class please circle Expert Clubman 50/50 Novice Beginner T-sh
ockA T-shockB PRE-65
Also tick if guest
INDEMNITY
HELMETS TO
BE WORN AS PER AMCA RULES
Declaration: Motor Sport can be dangerous a
nd may involve injury or death. You must read and agree to the following de
claration and paragraphs below which are designed to create a legally bindi
ng 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 enterin
g 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 co
mpetition
4 Before taking part in the event I will ensure ( Unless pro
hibited ) 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 co
mpete.
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 spor
t 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 an
d comply with general regulations, any supplements and final instructions i
ssued by the AMCA, the organisers and the circuit owners and the regulatory
body
8 I will not participate whilst under the influence of alcohol o
r intoxicating drugs and that if I am taking any prescribed medication I wi
ll inform the event organiser and seek approval to participate before takin
g part.
9 If under the age of 18, my parent / guardian has read the ab
ove and signed the declaration below.
Entrant's Signature ............
..................................................... Date ................
...............
Please complete below for entrant under 18 years. Plea
se state age .....................................
Parent / Guardian D
eclaration and Agreement To allow the applicant to enter the competition yo
u must agree to the matters set out below which are designed to create lega
l obligation on you. Sign below only if you agree
I...................
.............................................(Print Name) am parent / legal
guardian of..............................................................<
br />a) I have read the entry form and declaration completed by the applica
nt and confirm the answers are true
b) I confirm that he/she is compet
ent 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/her t
o take part, satisfy myself that the course and facilities are safe and wil
l inspect same.
d) I also hereby AGREE that if the applicant should su
stain any injury from any cause whilst taking part in the event and as a re
sult bring claim for compensation against you or the organisers or official
s or sponsors or entrants or owners of the venue I WILL INDEMNIFY AND PAY B
ACK TO YOU any sum which you may be required to pay as a result of such cla
im.
Signature of Parent /Guardian.....................................
............... Date .....................................
Address (if
different from applicant).................................................
...........................................................................
..............................................