RACE ENTRY FORM ENTRY

Size: px

Start display at page:

Download "RACE ENTRY FORM ENTRY"

Anne Woods
6 years ago
Views:

1 18 RACE ENTRY FORM ENTRY

2 HOW TO USE THIS FORM This is an electronic form that allows you to fill in your details and submit the form without having to print, scan or post. This form uses Adobe PDF Reader. You may be asked to update this software which is free from Adobe.com. STEP 1). Save this form to your computer STEP 2). Open and compete the form (Text will expand and contract to fill the allocated space so don t worry if you cannot read what you have written in full) STEP 3). Save the form to a specific location on your computer so you can access it later STEP 4). Attach the saved PDF file to an and send it to Hannah Wilson (hannah@butemotorsport.co.uk) ALTERNATIVE SUBMISSIONS You can also submit the form by faxing it to , or print and posting to: Bute Motorsport Ltd, Sparkford, Somerset BA22 7LH A paper form can also be sent to you if preferred. Please Hannah Wilson on hannah@butemotorsport.co.uk with your contact address or by telephoning or Held under the general regulations of the Motor Sports Association (incorporating the provisions of the International Sporting Code of the FIA) and the Supplementary Regulations. ENTRIES OPEN: On Publication. LATE ENTRY SUPPLEMENT: Entries made less than two weeks prior to the meeting may incur an additional administration fee. ENTRIES CLOSE: By noon on the Thursday prior to each round. TEAM INFORMATION NAME OF TEAM: MANAGER NAME: MAIN CORRESPONDENCE ADDRESS: POST CODE: MANAGER S MOBILE: ENTRANTS LICENCE NUMBER: _ ASN/GRADE: SPONSOR/TEAM NAME TO APPEAR IN PROGRAMME: TWITTER WEBSITE: www. 2

3 MEDIA INFORMATION DO YOU HAVE SOMEONE WHO LOOKS AFTER YOUR PR? YES NO PLEASE PROVIDE THEIR CONTACT DETAILS SO WE CAN ADD THEM TO OUR MEDIA LIST: PLEASE PROVIDE NAME AND CONTACT DETAILS FOR WEBSITES AND NEWSPAPERS LOCAL TO YOU SO WE CAN ADD THEM TO OUR MEDIA LIST: VEHICLE INFORMATION MANUFACTURER: MODEL NAME/TYPE: COLOUR:_ TRANSPONDER NUMBER: RACE NUMBER CHOICE: 1). 2)._ 3). (First come, first served basis. Number 1 not available) HOMOLOGATION FORM NUMBER: Any queries please call Phil Boland, Technical Co-ordinator on PADDOCK SPACE REQUIREMENTS Race car will be transported in: ARTICULATED TRUCK RIGID TRUCK TRANSPORTER VEHICLE / TRAILER COMBINATION RACE TRANSPORTER DETAILS: MAKE: LENGTH: MODEL: WIDTH: REGISTRATION NUMBER: MOTOR HOME / CARAVAN: MAKE: LENGTH: MODEL: WIDTH: REGISTRATION NUMBER: 3

DRIVER ONE INFORMATION NAME: NATIONALITY: ADDRESS: POST CODE: MOBILE: TELEPHONE: EMAIL:

BIRTH: OCCUPATION: EMERGENCY CONTACT NAME: _ RELATIONSHIP: MOBILE TELEPHONE NUMBER: FIA

4 DRIVER ONE INFORMATION NAME: NATIONALITY: ADDRESS: POST CODE: MOBILE: TELEPHONE: WEBSITE: TWITTER HANDLE: COMPETITOR LICENCE NUMBER: GRADE: ASN: ASN: DATE OF BIRTH: PLACE OF BIRTH: OCCUPATION: EMERGENCY CONTACT NAME: _ RELATIONSHIP: MOBILE TELEPHONE NUMBER: FIA RATING: BRONZE SILVER GOLD PLATINUM DRIVER ONE RACING CV: YEAR: CHAMPIONSHIP: POSITION: WINS/PODIUMS: 4

DRIVER TWO INFORMATION NAME: NATIONALITY: ADDRESS: POST CODE: MOBILE: TELEPHONE: EMAIL:

5 DRIVER TWO INFORMATION NAME: NATIONALITY: ADDRESS: POST CODE: MOBILE: TELEPHONE: WEBSITE: TWITTER HANDLE: COMPETITOR LICENCE NUMBER: GRADE: ASN: ASN: DATE OF BIRTH: PLACE OF BIRTH: OCCUPATION: EMERGENCY CONTACT NAME: _ RELATIONSHIP: MOBILE TELEPHONE NUMBER: FIA RATING: BRONZE SILVER GOLD PLATINUM DRIVER TWO RACING CV: YEAR: CHAMPIONSHIP: POSITION: WINS/PODIUMS: 5

declarations I wish to register for the 2018 LMP3 Cup Championship, which is jointly organised by Bute Motorsport and MotorSport Vision Racing (MSVR).

6 declarations I wish to register for the 2018 LMP3 Cup Championship, which is jointly organised by Bute Motorsport and MotorSport Vision Racing (MSVR). In signing this registration form I undertake to abide by the Regulations set out in the 2018 LMP3 Cup Championship Regulations and confirm receipt of a copy of the same. I also agree to abide by the Regulations of the MSA. The Driver and the Entrant hereby authorise Bute Motorsport and MSVR to use and licence the use of images and representations of the driver and team paraphernalia.this includes the logo and decals of all sponsors of the driver and/or entrant for the purpose of producing merchandise exploiting the reputation of the series. I further undertake to abide by any future amendments of clarifications that are sent to me by Bute Motorsport, MSVR or the MSA during the course of the 2018 season. GENERAL DECLARATION FOR COMPLETION BY ALL DRIVERS/COMPETITORS I the undersigned hereby make application to participate in the National A Race Meeting(s) to be held at these circuits on the dates specified. I certify that the particulars of my entry and my vehicle as given are correct. I declare that I have been given the opportunity to read the LMP3 Cup Championship regulations and general regulations of the Motor Sports Association and, if any, the Supplementary regulations for this event and agree to be bound by them. I declare that I am physically and mentally fit to take part in the event and I am competent to do so. I acknowledge that I understand the nature and type of the competition and the potential risk inherent with motor sport and agree to accept that risk. I understand that motorsport can be dangerous and accidents causing death, injury, disability and property damage can and do happen. I understand that these risks may give rise to my suffering personal injury or other loss and I acknowledge and accept these risks. In consideration of the acceptance of this entry I agree that neither any one of or any combination of the MSA and its associated clubs, the organisers, the track owners or other occupiers, the promoters and their respective officers, servants, representatives and agents (the Parties ) shall have any liability for loss or damage which may be sustained or incurred by me as a result of participation in the Event including but not limited to damage to property, economic loss, consequential loss or financial loss howsoever caused. Nothing in this clause is intended to or shall be deemed to exclude or limit liability for death or personal injury. To the fullest extent permitted by law I agree to indemnify and hold harmless each of the Parties in respect of any loss or damage whatsoever and howsoever arising from my participation in this event. I declare that to the best of my belief the driver(s) possess(es) the standard of 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 all persons having any connection with the promotion and/or organisation and/or conduct of the event are insured against loss or injury caused through their negligence. I understand that should I at the time of this event be suffering from any disability whether permanent or temporary which is likely to affect prejudicially my normal control of my vehicle, I may not take part unless I have declared such disability to the ASN, which has, following such declaration, issued a licence which permits me to do so. I undertake that at the time of the event to which this entry relates I shall have passed or am exempt from an ASN specified medical examination within the specified period. I have read and fully understood the Procedure for Control of Drugs and Alcohol as contained in the Competitors and Officials Yearbook Regulations H39, D35.1, G and have also fully familiarised myself with the information on the web sites referred to ( and in particular the UK Anti Doping Rules which have been adopted by the MSA. Further, if I am counter-signing as the Parent or Guardian of a minor then in addition to the deemed consent to the testing of that minor (UKAD Code Art 5.6.2) I hereby confirm that I give such consent for the minor concerned to be so tested. I hereby agree to abide by the MSA Safeguarding Policy and Guidelines and the National Sporting Code of Conduct. IMPORTANT: Any indemnity and/or declaration as prescribed by the paragraphs to the above that is signed by a person under the age of 18 shall be countersigned by that person s parents or guardian, whose full name and address shall be given below: Note: In the event that the parent is not present at the event, a Parental Consent Authorisation form must be produced in accordance with MSA Regulation D This form can be found on the MSA website: 6

SIGNATURES TEAM/ENTRANT: DATE: SIGNATURE OF DRIVER ONE: _ DATE: SIGNATURE OF DRIVER TWO (if applicable): DATE: PARENT/GUARDIAN SIGNATURE (if under 18): DATE: ENTRY FEE Full season price: 15,600 (

7 SIGNATURES TEAM/ENTRANT: DATE: SIGNATURE OF DRIVER ONE: _ DATE: SIGNATURE OF DRIVER TWO (if applicable): DATE: PARENT/GUARDIAN SIGNATURE (if under 18): DATE: ENTRY FEE Full season price: 15,600 ( 18,720 including VAT) PAYMENT METHOD I WISH TO PAY BY DIRECT DEBIT/CREDIT CARD (Additional 2.5% will be added to credit card transactions) CARD TYPE: ELECTRON DEBIT VISA MASTERCARD OTHER NAME ON CARD: CARD NUMBER: START DATE: / EXPIRY DATE: / CV2 CODE: An invoice will be issued on receipt of payment. Please state separately if invoice name and address details are to be different from those above. PAY BY CHEQUE (payable to Bute Motorsport Ltd.) BACS PAYMENT Sort: Account No: IBAN: GB62HAND

8 Championship Director Hannah Wilson Mobile Telephone hannah@butemotorsport.co.uk Technical Co-ordinator Philip Boland Mobile phil@butemotorsport.co.uk Marketing & Media Co-ordinator Thomas Baker Mobile tom@butemotorsport.co.uk Bute Motorsport Limited Sparkford, Nr. Yeovil, Somerset BA22 7LH

2.Bentley Handicap (pit lane start) 15 Mins (i). Bentley Open Race 3(ii). Allcomers Scratch Race. (i) 215 B FISCAR 30 Mins

2.Bentley Handicap (pit lane start) 15 Mins (i). Bentley Open Race 3(ii). Allcomers Scratch Race. (i) 215 B FISCAR 30 Mins Bentley Drivers Club Silverstone Race Meeting 4 th August 2018 MSA Permit No, Clubmans:TBA No, Nat B: TBA ENTRY FORM Held under the General Regulations of The Motor Sports Association (incorporating the