JERSEY MOTOR CYCLE & LIGHT CAR CLUB

CLOSED SPEED COMPETITION

Entry Form - Motor Cars

EVENT:…………………………………………………………………………………..…………........………………….………
TO.BE.HELD.AT:……………………………………………………..…. DATE:……………………………………………
Under the General Regulations of the MSA Motor Sports Association (incorporating the provisions of the International Sporting Code of the FIA) the Standing Competition Rules and Supplementary Regulations of the Club.
PLEASE WRITE IN BLOCK LETTERS TEL NO:........................................................................
ENTRANTS NAME:…………………………………………………. MSA COMP. LICENCE NO:….…………..
ENTRANTS ADDRESS:………………………………………………………………………………………………..……….
DRIVERS NAME:……………………………. …………………….. MSA COMP. LICENCE NO:…………………
DRIVERS ADDRESS:………………………………………………........……………………………………………………….
DRIVERS AGE(if under 20 years)……………………………..….… COMPETITION NO:……………………….…………
MAKE OF CAR:………………………………………………..…… MODEL:……………………………………………….
C.C.:…………………. TURBOCHARGED: YES/NO SUPERCHARGED: YES/NO
...KARTS .......... ..........RALLY CARS. .................MOD PROD. ..............SPORTS GT/LIBRE.... .........RACING CARS........
100cc upto 1300 upto 1400 upto 1300 uptp500
125cc 1301-1600 1401-1600 1301-2000 501-1100
250cc 1601-2100 1601-2000 Unlimited 1101-1600
Unlimited Unlimited 1601-2000
2001-3000
Unlimited
I have read the supplementary regulations issued for this event and agree to be bound by them and by general regulations of the MSA Motorsport LTD. In consideration of the acceptance of this entry and of my being permitted to take part in the event, in respect of any part of the event not held on the publicly adopted road, I agree to save harmless and keep indemnified the MSA MOTORSPORTS association Ltd such person or persons or body as may be authorised by the MSA MOTORSPORTS association Ltd to promote this event and their 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 or injury or damage to property of myself, my driver(s), passenger(s), mechanic(s), or associated personal, arising out of or in connection with this entry.
a In the case of races or Speed Events "I declare that to the best of my belief the driver(s) possess(es) the standard of competence necessary for the event of the type to which this entry relates and that the vehicle entered is suitable and roadworthy for the event having regard for the course and the speeds which will be reached.
b In the event of any race taking place wholly or partly on the public highway: "I declare that the use of the vehicle hereby entered will be covered by insurance as required by the law which is valid for such parts of this event as shall take place on roads as defined by the law.
I understand that should I at the time of this event be suffering from any disability weather permanent or temporary which is likely to effect prejudicially my normal control of my vehicle. I may not take part unless I have declared such disability to the MSA Motor Association LTD who have, following such declaration, issued a licence which permits me to do so.
DATE:…………………………………… DRIVERS SIGNATURE:..…………………………..………………………….
ENTRANTS SIGNATURE:…………………………..…………………………
NOTE:- IF ENTRANT OR DRIVER IS UNDER 21 YEARS OF AGE THIS FORM MUST BE COUNTER SIGNED BY THEIR APPROPRIATE PARENT OR GUARDIAN.
PARENT/GUARDIAN’S SIGNATURE:……………………………………………….……………………………………
NAME & ADDRESS:………………………………………….……………………………………….…………….………
…………………………………………………………………………………… TEL NO: ………….………………….….
Name and address of a relative or friend to be informed in the case of a serious accident.
Name:……………………………… ………………… Address: ……………….……………………..…………….………
………………………………………………………… Telephone Number: ………………………….…………………….
THE SPEED COMMITTEE WILL NOT BE RESPONSIBLE FOR ANY ERROR IN CONNECTION WITH THIS ENTRY IF THE FORM IS NOT CORRECTLY OR COMPLETELY FILLED IN.