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  • Race entry form

  • As from 01/01/08 ONLY this Entry Form will be accepted by all clubs

    N.I.K.A.
    Race Letters

      N.I.K.A.
    Race Number

    Venue:   Date:
    Race entry fee:    
    Club Member No:   MSA Licence No:
    Competitors Name:   Postcode:
    Address:
    Competitor's day and evening Tel Nos:
    Transponder Code (competitor owned):
    Entrant's Name:
    (if applicable)
      Entrants Licence No:
    Entrant's Address:
    Entrant's day and evening Tel Nos:
    Entrant's e-mail address:
    Are you a RESTRICTED driver:
    (i.e. are you a BLACK Plate competitor)
    YES     NO    (tick as appropriate)
    Chassis make:   Engine make:
    Next of Kin:   Tel No:
    Address:
    CLASS ENTERED F. Cadet (comer)   Honda Cadet   Mini Max
    (tick as appropriate) F.Jnr Max   KF 3   World Formula
      F. TKM (extreme)   Pro Kart   F. Max 177
      F. 125 Max   KF 2   F. S/K 125
      F. S/K 250   Other Class
    (please state)
         
    Held under the General Regulations of the Motor Sports Association (incorporating the provisions of the International Sporting Code of the FIA) and any supplementary Regulations.

    I declare that:

    1. I have been given an opportunity to read the 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 event and the potential risk inherent with motor sport and agree to accept that risk.

    2. 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.

    3. I understand that should I at any time of this event be suffering from any disability whether permanent or temporary which is likely to affect prejudicially my normal control of the 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.

    4. 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. (H.10.1.6)

    5. If I am the Parent/Guardian/Guarantor of the driver I understand that I 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. As the Parent/Guardian/Guarantor I confirm that I have acquainted myself with the MSA General Regulations, agree to pay any appropriate charges and fees pursuant to those Regulations (to include any appendices thereto) and hereby agree to be bound by those Regulations and submit myself without reserve to the consequences resulting from those Regulations (and any subsequent alteration thereof). Further, I agree to pay as liquidated damages any fines imposed upon me up to the maxima set out in Part 3, Appendix 1.

    Note: Where the Parent/Guardian/Guarantor is not present there must be a representative who must produce a written and signed authorisation to so act from the Parent/Guardian/Guarantor as appropriate.

    6. I hereby agree to abide by the MSA Child Protection Policy and Guidelines.

    PLEASE BE AWARE THAT BY SIGNING ON YOU ARE ENTERING INTO A LEGALLY BINDING CONTRACT
    By clicking the ‘SEND FORM’ button you are agreeing to the statements printed on this form.

    Date of Birth:
    (state over 18, if applicable)
    E-mail:

    NOTE: If a driver is UNDER 18 years of age, this form MUST be counter signed by that person's Parent/Guardian/Guarantor. If a Parent/ Guardian is not at a meeting with a driver UNDER 18 years of age, please ensure that the person acting as Guarantor has the WRITTEN AUTHORITY to act on behalf of the absent Parent/Guardian & present such documents at signing on.

    Parent/Guardian/Guarantor Name:
    (delete PARENT / GUARDIAN / GUARANTOR
    as appropriate)
    Address:

    NOTE: Unless advised otherwise to the organisers, entry is considered acceptance for the organisers to publish on-the-track racing photos of the competitor for race reports and event publicity use. Only photographers or journalists approved by the organisers will be granted such permission. Such photographers will always ask the entrant's permission before taking any off-track photos for use with race reports or event publicity use.

    Payment options: Post cheque to Peter Rutherdale, 71 Holly Hill, Dollingstown, Co Armagh BT66 7UB
    Online payment (PayPal)

    It's is the responsibility of the COMPETITOR/ENTRANT to ensure that ALL above details are COMPLETE, CORRECT & LEGIBLE.
    By clicking the ‘SEND FORM’ button you are agreeing to the statements printed on this form.

    Ulster Karting Club|Regulations

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