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All Entrants MUST provide a clear external (front-on) photograph of their vehicle, as spots are

limited. West Coast Nats reserves the right to refuse entry to any vehicle as Entrant numbers are

capped at 180. Photos can be attached to the entry form or emailed to westcoastnats@bigpond.com

Entrant Name:

Postal Address:

Email Address:

Mobile Number:

Phone: (W/H)

AASA License:

Vehicle Make: Vehicle Model: Colour: Engine:

Supercharged: Turbo: N/A:

Fuel Type: Vehicle Name / License Plate:

Entering with a Group (Y/N): Group Name: Marquee Required (Y/N:): No of Cars:

Event Yes/No

Burnouts Blown Open:

Powerskids

Cruise the Track

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(Price includes Vehicle, Driver, Camping and 1 Weekend Buddy Pass)

Please tick below in Boxes .

Entrant fee includes camping for the entrant & buddy ONLY

ENTRANT Fee $200.00 (Includes GST) $200.00

Event Long Sleeve Please tick S M L XL XXL XXXL $ No Charge

Extra Event Tee Please tick S M L XL XXL XXXL $40.00 ea $

Towing ENTRANT Car FREE if entrant car on trailer $No Charge

Support Vehicles (limit of 1 only) YES $40.00 each $

Buddy DAY Pass @ $40.00 SAT or $30 FRI or SUN (No Camping Allowed)

Saturday 1 2 3 4 5

Friday or Sunday 1 2 3 4 5

$

Weekend Buddy pass NO CAMPING - $70.00

1 2 3 4 5 6 7 8 9 10 11 12 13

$

Weekend Buddy pass including Camping @ $100.00 each

1 2 3 4 5 6 7 8 9 10 11 12 13

$

Open Powered Carports @ $250 Each $

Open Un-powered Carports @ $150 Each $

PAYABLE BY Money Order Funds Transfer

BSB: 086-334 Account: 16-673-1137

Name: West Coast Nats Pty Ltd TOTAL AMOUNT

$

*Please nominate if you require a carport, these are limited and will be

allocated by the Promoter.

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EXCLUSION OF LIABILITY, RELEASE AND ASSUMPTION OF RISK Drivers, Crew, Competitors & Buddies

WEST COAST NATS 2017 (“the Event”)

At Collie Motor Plex (“Venue”)

In exchange for being able to enter, attend or participate in the Event I/We agree:

* To release West Coast Nats (“WCN”), Collie Motorplex (“CMP”) and Motoring

Southwest (“MSW”), promoters, sponsor organizations, land owners and lessees,

organizers of the event, their respective servants, officials, representatives and

agents (collectively, the “Associated Entities”) from all liability for my death, personal

injury (including burns), psychological trauma, loss or damage (including property

damage) which may be sustained or incurred by me as result of participation in or

being present at the event.

* that WCN, CMP & MSW and the Associated Entities do not make any additional

warranty, implied or express, that the Event services will be provided with due care

and skill or that any materials provided in connection with the services will be fit for

the purpose for which they are supplied, except for any warranty necessarily imposed

by the provisions of the Trade Practices Act (1974); and

* participate in the Event at my/our own risk.

* I/We being the owner of the vehicle described in this entry form confirm that the

vehicle is roadworthy and meets or exceeds the safety requirements. ‘

* The information provided in this entry form is true & correct to the best of my

knowledge.

* By submitting this form I acknowledge that I have read, understood and agree to

abide by the terms & conditions outlined in this entry form, disclaimer and the West

Coast Nats Event guide.

I acknowledge that the risks associated with attending or participating in the Event includes

the risk that I may suffer harm as a result of:

* Motor vehicles (or parts of them) colliding with other motor vehicles, persons or

property.

* Acts of violence and other harmful acts (whether intentional or inadvertent)

committed by persons attending or participating in the Event; and

* The failure of facilities (including grand-stands, fences and guard rails) at the Event.

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By entering this event you agree that West Coast Nats may use the photographs provided

with this entry for promotional purposes, or photographs or video footage taken at the event of

yourself or your vehicle for future promotion of the event including DVD production, YouTube

coverage, Facebook or website use.

I/We declare that I/we have read and understood the additional Regulations issued in the West Coast

Nats Event Guide, and agree to be bound by them and the relevant provisions of the Competition Rules

of the Confederation of Australian Motorsport (CAMS) and/or the Australian National Drag Racing

Association (ANDRA), as applicable to the event.

All Drivers must be a minimum of 18 years of age and hold a current Driver’s License,

learners Permits are not permitted.

Accepted vehicles must be road registered, unregistered vehicles will be accepted at

the promoter’s discretion.

Once your entry has been accepted and payment submitted your entered vehicle

cannot be changed without prior consent of Promoters. WCN reserves the right to

refuse entry if the replacement vehicle is not of the same / similar standard to the

original vehicle entered.

Entrants are required to ensure the vehicle will pass a safety check, including but not

limited to; steering, brakes, battery clamp, working brake lights, radiator overflow bottle,

seat belts and working windows.

Drivers need to be aware that for the duration of the event their vehicle is not covered

by their insurance and West Coast Nats accepts no responsibility for any damage

sustained to the vehicle for the duration of the event.

West Coast Nats is an alcohol free event and drivers will need to maintain a 0.00 Blood

Alcohol reading, failure to adhere to this requirement will see the entrant armband

removed for the duration of the event.

All Competitors are required to wear enclosed shoes for Cruise the Track and for

Burnouts & Powerskids are also required to wear a long-sleeve shirt and long pants

and approved helmet.

All Competitors need to attend the Drivers briefing on Friday (bump-in day) and sign

the appropriate waiver. If Drivers aren’t able to attend the Friday briefing a 2nd briefing

will be run on Saturday morning.

Any person driving or attempting to drive a vehicle without the correct armbands will

see that vehicle removed from competition or track cruising, entrants are responsible

for their own vehicle and their passenger actions.

Passengers are allowed for the Burnouts but they must sign in as a Buddy and have

the relevant arm band and sign the waiver.

By signing this document entrants accept that no refund will be given if they cancel

their entry within 14 days of the event, of if the event is affected by weather and

cancelled due to safety reason entrants will forfeit their entry fee.

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If the entrant cancels their entry prior to 14 days before the show they will receive a

refund of their entry fee (minus an $80 administration fee). A replacement vehicle will

be sourced by the Promoter.

The Promoter has the right to cancel or withdraw any entrant from the event for any

behavior deemed aggressive or unsafe (on or off the track). The entrant’s armband will

be removed and their car removed the venue, no refunds will be given.

Failure to abide by the Promoters / Track Officials instructions will result in immediate

cancellation of your entry, this includes physical or verbal abuse towards the Promoter

or Track Official.

Any antisocial or violent behavior inside the venue during the event will not be tolerated

and Promoters will not hesitate to evict.

MOTORSPORT IS DANGEROUS

The undersigned, admitted by use of the license that is granted to West Coast Nats by, assumes all

risk (including death, psychological trauma, severe burns and other serious injuries) incidental to this

Event and agrees that all participants and all employees, agents, officers and Directors of the

Associated Entities are hereby released from all such injuries, damages or claims.

I ____________________________________________ (PRINT NAME) being the Driver, certify that

the particulars on this entry form are true and correct in every particular, to the best of my/our knowledge

and belief and I accept the conditions of, and acknowledge the risks arising from, attending or

participating in the event and being provided with the Event services by the Associated Entities.

Signature of Entrant / Driver:__________________________________ Date: ______/ ______/ ____

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AUSTRALIAN AUTO-SPORT ALLIANCE Pty. Ltd.

79 Rowan Street Wangaratta Vic 3677

RELEASE AND WAIVER OF LIABILITY

ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

WARNING! Motor Racing is Dangerous and accidents can and do happen. All care is taken

to protect you but you are warned that there is a possibility of an accident causing injury, death

or property damage.

Subject to that warranty, if applicable and IN CONSIDERATION of being permitted to compete, officiate,

observe, work for, or participate in any way in the EVENT(S) or being permitted to enter for any purpose any

RESTRICTED AREA (defined as any area requiring special authorization, credentials, or permission to enter any

area to which admission by the general public is restricted or prohibited), EACH OF THE UNDERSIGNED, for

himself/herself, his/her personal representatives, heirs and next of kin.

1. Acknowledges, agrees and represents that he/she enters and he/she further agrees and warrants that, if at any

time, he/she is in or about RESTRICTED AREAS and he/she feels anything to be unsafe, he/she will

immediately advise the officials of such and will leave the RESTRICTED AREAS and/or refuse to participate

further in the EVENT(S).

2. HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE Australian Auto-

Sport Alliance Pty. Ltd., the landowners, promoters, participants, racing associations, sanctioning

organizations or any subdivision thereof, track operators, officials, car owners, drivers, pit crews, rescue

personnel, any persons in any RESTRICTED AREA, promoters, sponsors, advertisers, owners and lessees

of premises used to conduct the EVENT(S), premises and event inspectors, surveyors, underwriters,

consultants and others who give recommendations, directions or instructions or engage in risk evaluation or

loss control activities regarding the premises or EVENT(S) and each of them, their directors, officers, agents

and employees, all for the purposes as herein referred to as “Releases”, FROM ALL LIABILITY, TO THE

UNDERSIGNED, his/her personal ON ACCOUNT OF INJURY TO THE PERSON OR PROPERTY OR

RESULTING IN DEATH OF THE UNDERSIGNED ARISING OUT OR RELATED TO THE EVENT(S),

WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

3. HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the Releases and each of

them FROM ANY LOSS, LIABILITY, DAMAGE OR COST they may incur arising out of or related to the

EVENT(S) WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

4. HEREBY ASSUMES FULL RESPONSIBILITY FOR ANY RISK OF BODILY INJURY, DEATH OR

PROPERTY DAMAGE arising out of or related to the EVENT(S) whether caused by the NEGLIGENCE

OF RELEASEES or otherwise.

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5. HEREBY acknowledges that THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and

involve the risk of serious injury and/or death and/or property damage. Each of the UNDERSIGNED also

expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY

NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES.

6. Hereby assumes full responsibility for the preparation and safety of the vehicle to be used and further give an

assurance that the vehicle has been checked for safety and is in a condition fit to be used for motor racing.

7. Hereby agrees that this Release and Waiver of Liability, Assumption of risk and Indemnity Agreement

extends to all acts of negligence by the Releases, INCLUDING NEGLIGENT RESCUE OPERATIONS and is

intended to be as broad and inclusive as is permitted by the laws of the State/Territory in which the

Event(S) is/are conducted and that if any portion thereof is held invalid, it is agreed that the balance shall,

notwithstanding, continue in full legal force and effect.

I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND

INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN

UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY

WITHOUT ANY INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME AND INTEND

MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE

GREATEST EXTENT ALLOWED BY LAW.

Signed, this day of 2017

First Name: ……………….……………………………………

Surname: ………………………….………………

D.O.B……………………..

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Signature:

Address:

Mobile:

Email:

PLEASE PRINT

CONSENT FOR ENTRANTS AND COMPETITORS UNDER 18 YEARS

I being the parent/guardian of

(please name),

have read the whole of this document and consent to him / her participating. In doing so, I acknowledge that Motor

Sport is dangerous, and agree that neither Australian Auto-Sport Alliance Pty. Ltd. nor “the organisers” shall be

under any liability whatsoever for any death or bodily injury, loss or damage which may be sustained or incurred by

the above named minor, or by me, howsoever such death or bodily injury, loss or damage is caused by negligence

or otherwise.

Signed: Date:

SIGNATURE OF PARENT / LEGAL GUARDIAN