Race Entry Form 2009 Postal
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THIS FORM IS ALSO AVAILABLE FOR SUBMISSION AND PAYMENT ONLINE AT www.dykc.co.uk Durham & Yorkshire Kart Club Race Entry 2009 Please return this form with your fee to: Mrs Anne Laws, Competition Secretary, 2 Matfen Place, Newcastle-upon-Tyne. NE4 9DN Date of Meeting Race Class First Names Surname Street & House Number THIS FORM IS ALSO AVAILABLE FOR SUBMISSION AND PAYMENT ONLINE AT www.dykc.co.uk Postal Town County Postcode Day Tel No Mobile Email Address Licence No Grade (tick one) Non MSA Int A Nat A Nat B Transponder No Chassis Racing Engine Home Club Are you a Novice? Y N Preferred Racing Number 1st Choice 2nd Choice 3rd Choice I have read the Supplementary Regulations issued for this event and agree to be bound by them and the General Regulations of the Motor Sport Association Ltd in consideration of the acceptance of this entry and of my being permitted to take part in this event, in respect of any parts of the event not held on a publicly adopted road, I agree to save harmless and keep indemnified The Motor Sport Association Ltd, such person, persons or Body as may be authorised by the Motor Sports Association Ltd to promote or organise this event and their respective Officials, Servants, Representatives and Agents together with other competitors and their respective Servants, Representatives and Agents, from and against all actions, claims, costs, expenses and demands in respect of Death of or Injury to or Damage to the Property of myself, my Driver(s), Passenger(s), Mechanic(s) or associated personnel, arising out of or in connection with this entry or my taking part in this event. Over 18? Y N Age if under 18 Date of Birth (under 18's) I declare that to the best of my belief, the driver(s) possess(es) the standard 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 speeds which will be reached. I understand that at the time of the event to which this entry relates I shall have passed an ASN specified medical examination within the specified period Driver's Signature Counter signature for drivers under 18 Name and address of next of kin I am the Parent / Legal Guardian / Guarantor (delete as appropriate) of the above and understand that I or my Guarantor shall have the right to be present during any procedure being carried out under the Supplementary Regulations issued for this event and the General Regulations of the MSA. When a Guarantor’s representative attends an event with a minor and signs on as his entrant, the representative must produce the Guarantor’s written and signed authorisation to so act Entrant Entrant Licence No CLOSING DATE FOR ENTRIES IS SEVEN DAYS BEFORE THE RACE DATE. ENTRY FEE £42 members; £52 non-members. TRANSPONDER HIRE FEE £10 Entry form without correct fee £10 extra. Tel / Fax entries £10 extra. ALL CHEQUES TO BE MADE PAYABLE TO DURHAM AND YORKSHIRE KART CLUB (DYKC) IF YOU REQUIRE CONFIRMATION PLEASE ENCLOSE SAE
Transcript of Race Entry Form 2009 Postal
THIS FORM IS ALSO AVAILABLE FOR SUBMISSION AND PAYMENT ONLINE AT www.dykc.co.uk
Durham & Yorkshire Kart Club
Race Entry 2009
Please return this form with your fee to: Mrs Anne Laws, Competition Secretary, 2 Matfen Place, Newcastle-upon-Tyne. NE4 9DN
Date of Meeting Race Class
First Names Surname
Street & House Number
THIS FORM IS ALSO AVAILABLE FOR SUBMISSION AND PAYMENT ONLINE AT www.dykc.co.uk
Postal Town County
Postcode Day Tel No Mobile
Email Address Licence No
Grade (tick one) Non MSA Int A Nat A Nat B Transponder No
Chassis Racing Engine
Home Club Are you a Novice? Y N
Preferred Racing Number 1st Choice 2nd Choice 3rd Choice
I have read the Supplementary Regulations issued for this event and agree to be bound by them and the General Regulations of the Motor SportAssociation Ltd in consideration of the acceptance of this entry and of my being permitted to take part in this event, in respect of any parts of theevent not held on a publicly adopted road, I agree to save harmless and keep indemnified The Motor Sport Association Ltd, such person, persons orBody as may be authorised by the Motor Sports Association Ltd to promote or organise this event and their respective Officials, Servants,Representatives and Agents together with other competitors and their respective Servants, Representatives and Agents, from and against all actions,claims, costs, expenses and demands in respect of Death of or Injury to or Damage to the Property of myself, my Driver(s), Passenger(s),Mechanic(s) or associated personnel, arising out of or in connection with this entry or my taking part in this event.
Over 18? Y N Age if under 18 Date of Birth (under 18's)
I declare that to the best of my belief, the driver(s) possess(es) the standard competence necessary for an event of the type to which this entry relates andthat the vehicle entered is suitable and roadworthy for the event having regard to the course and the speeds which will be reached.I understand that at the time of the event to which this entry relates I shall have passed an ASN specified medical examination within the specified period
Driver's Signature Counter signature for drivers under 18
Name and address of next of kin
I am the Parent / Legal Guardian / Guarantor (delete asappropriate) of the above and understand that I or my Guarantorshall have the right to be present during any procedure beingcarried out under the Supplementary Regulations issued for thisevent and the General Regulations of the MSA.When a Guarantor’s representative attends an event with a minorand signs on as his entrant, the representative must produce theGuarantor’s written and signed authorisation to so act
Entrant Entrant Licence No
CLOSING DATE FOR ENTRIES IS SEVEN DAYS BEFORE THE RACE DATE.ENTRY FEE £42 members; £52 non-members. TRANSPONDER HIRE FEE £10
Entry form without correct fee £10 extra. Tel / Fax entries £10 extra.ALL CHEQUES TO BE MADE PAYABLE TO DURHAM AND YORKSHIRE KART CLUB (DYKC)
IF YOU REQUIRE CONFIRMATION PLEASE ENCLOSE SAE
