AUTOCROSS 10-11 SEPTEMBER 2022

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AUTOCROSS ENTRY FORM

Email *

NAME *

ADDRESS *

MOBILE NUMBER *

I am aged over 18 *

Yes

Are you a disqualified driver ?

Yes

Clear selection

Under 18's only Consent of Parent or Guardian Name

Under 18's only Consent of Parent or Guardian Address

Under 18's only Consent of Parent or Guardian Telephone number

Under 18's only Consent of Parent or Guardian Relationship

CLUB *

Club Membership number

Motorsport UK Competition Licence Number *

Competition Licence grade

Entrant (if applicable) Name

Entrants MotorsportUK Licence Number

Entrants Phone number

Double driven *

Yes

Event = Clubman / Interclub *

Interclub

Clubman

Class entered *

Competition Number

ASWMC Championship entered

Yes

MAKE & MODEL OF CAR

C.C

Fitted with turbo / super charger

Yes

Contact in case of serious accident: name / relationship / contact number *

Will this person be at the event

Yes

Clear selection

Entry fee

£40 Under 18 Saturday

£60 Under 18 on 31/08/22 both days

£ 80 Sunday

£80 Saturday

£40 Under 18 Sunday

£ 130 both days

Clear selection

Option 1

Clear selection

Entry fee paid

Bank Transfer SRs 5.7

Cheque / other

Clear selection

PRIVACY: We take your privacy seriously and will only use your personal information to administer your entry, including providing a public Entry List and sending you emails in connection with your entry. Some of your information will be passed on to the organisation providing results for the event. I declare that I have been given the opportunity to read the General Regulations of Motorsport UK 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. Further, 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..

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