OFFICIAL ENTRY FORM QRA QUAD, MINIBIKE & SXS Miniduro’s & Speedway Event date : Sunday 16th November 2014 At Grangewood Farm, Idover Lane, DAUNTSEY, Wiltshire SN15 4JL From M4 J17 (Chippenham) 8.5miles to G8) From M4 J16 (Swindon) 7.5 miles PERMIT No MCF1400** PLEASE USE CLEAR BLOCK WRITING Held under the standing regulations of the MCF, the club and any rules and regulations, supplementary Regulations and final instructions of the permit issuing authority as have or that my be issued for the good conduct and safe running of the event. I, the undersigned, apply to enter the event described in this entry form. In consideration of being permitted to participate in this event I declare as follows: That I have read the Codes of Practice and Regulations for the MC Federation, the Event Regulations and entry form (when applicable) and I agree to be bound by them in every respect. That I am fit and not suffering from any physical or mental disability which would impair my safe participation in the event. I undertake to inform the MC Federation immediately should any change in my condition occur which I have reason to or ought to have reason to believe would affect my ability to participate in this competition. That I have completed a medical questionnaire form (as requested during your licence application or in section 2 of this form ) and that I will inform the MC Federation should my medical status have changed. As a participant I may be exposed to the risk inherent in motor sport and that I am prepared to take such risks. I further agree that I shall not seek to claim against MC Federation, the organisers, their officials, the land owners, the promoter or other bodies or individuals connected with the event(s) in respect of any damage to my property howsoever caused, and whether by negligence or breach of statutory duty of the said bodies or persons. MC Federation do not provide personal accident insurance. SECTION 1 - ENTRY DRIVER Surname ……….……………………………………… First Name(s) …………………………………………………….. . Address ………………………………………………….………………………….……………………………………………………………………… …………………….…………………………………………………………………………………………….Post Code…………………................... Home Tel; …………………………………………………………Mobile Tel; ………………………………………………………… Age ……………….. DOB………………………….. Email ………………………………………………………………………. MCF Licence No………………..…………….................................................................or Event Licence £10?.......... Machine; Usual race number: ______ Team Name ……………………………………………………………………………………………………………………. Make …………………….Model ……………………………………………………4x4? ……………... Capacity ………..cc Stroke……… Bore ………… MINIDURO’S CLASS/ES ENTERED; SXS OPEN _____ QUAD MINIDURO CLASSES; OPEN QUAD ____ EVO QUAD / TRIKE ____ 4X4 QUAD ____ SPEEDWAY EVENT CLASS/ES; ‘C’ = OPEN QUAD ‘D’ = UPTO 300cc QUAD ‘E’ = 4X4 UP TO 600cc ‘F’ = 4X4 OPEN ‘G’ = EVO QUAD/TRIKE _____ _____ _____ _____ _____ th Will you attend the SKITTLES on Saturday 15 November – There will be a total of ______ people in my party. Sponsors/programme listing ………………………………………………………………………………………………………………………………. Transponder Number: ................................................................................................ HIRE ONE PLEASE YES □ □ NO Entrants from outside mainland UK must hold a current valid European (A) (B) Licence, start permission and insurance. QUAD / MINIBIKE Miniduro/Speedway - ENTRY FEE’S BOTH EVENTS MINIDURO & SPEEDWAY Entry Fee If you don’t have your own AMB Transponder hire (1 per team) MCF Event Licence £10 each Driver/Passenger Please return your completed entry form & payment; Gaynor £50 £10 on the day £10 on the day CHEQUES MADE PAYABLE TO:- ‘SXS RACING’ Nash, 74 Roman Way, Andover, Hants SP10 5JJ