Donington Winterseries 2017 - 2018 Autosolo Entry Form

Driver / Name & contact info of person to be contacted in case of a serious accident
Name
Address /
Tel No.
Full Driving License? / Yes / No / Relationship to Driver:
Age / 14 / 15 / 16 / 17 / Over 18 / If under 18 complete young person form attached
Email: / To be used for all paperwork
Club / You may enter under more than one club. The first club you list will be used for series club points
Fee / Paid / Comp No / Passengers Name
R1: 25th November 2017 / £25
R2: 9th December 2017 / £25
R3: 20th January 2018 / £25
R4: 17th February 2018 / £25
Mid Derbyshire MC Championship Membership / £1 / This year championship will be administered by Mid Derbyshire Motor Club (MDMC). To register for the championship, please tick to confirm your agreement to your details being used for this purpose. You must be a member of MDMC, Loughborough CC or an invited club
Car
Make & Model / CC
Forced Induction / Yes / No If Yes a 1.7 to 1 multiplier is applied to the capacity
Advantage Class Declaration / Yes / No See below for definition
Class / A B C D E F / Touring / Open / Closed
Car Shared With
Class A / Class B / Class C / Class D / Class E / Class F
Up to and Including 1000cc / 1001cc up to 1400cc / 1401cc up to 1600cc / 1601cc up to 2000cc / 2001cc and above / Advantage

Donington Winterseries 2017/2018 Passenger Form

Note passengers are optional for the Autosolo and obligatory for the PCA

Driver:
Passenger / Round 1 2 3 4 / Name & contact info of person to be contacted in case of a serious accident
Name
Address
Tel No.
Full Driving License? / Yes / No / Relationship to passenger:
Age / 12 / 13./14 / 15 / 16 / 17 / Over 18 / If under 18 complete young person form attached
Club / Passengers need to be members of an invited club. Winterseries membership of Mid- Derbyshire MC is available for £1
Passenger / Round 1 2 3 4 / Name & contact info of person to be contacted in case of a serious accident
Name
Address
Tel No.
Full Driving License? / Yes / No / Relationship to passenger:
Age / 12 / 13./14 / 15 / 16 / 17 / Over 18 / If under 18 complete young person form attached
Club / Passengers need to be members of an invited club. Winterseries membership of Mid- Derbyshire MC is available for £1
Passenger / Round 1 2 3 4 / Name & contact info of person to be contacted in case of a serious accident
Name
Address
Tel No.
Full Driving License? / Yes / No / Relationship to passenger:
Age / 12 / 13./14 / 15 / 16 / 17 / Over 18 / If under 18 complete young person form attached
Club / Passengers need to be members of an invited club. Winterseries membership of Mid- Derbyshire MC is available for £1

Donington Winterseries 2017/2018 Young Driver/Passenger Indemnification

Indemnification Declaration

The indemnification as per GR D.13 will be included in the signing on sheet which all competitors must sign on arrival at the event as per GR H33.1.1.

If, however, the Entrant/Driver/Passenger will be under the age of 18 on the day of the event that person’s parent or guardian must complete the section below.

Name of Driver / Passenger

If I am the Parent or Guardian 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 ‘I confirm that I have acquainted myself and the minor 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

GUARDIAN’S NAME:
RELATIONSHIP TO DRIVER: / SIGNATURE:
ADDRESS:
TEL:

Note: Where the Parent/Guardian/Guarantor will not be present at the event there must be a representative who must produce a written and signed authorisation to so act from the Parent/Guardian/Guarantor. Forms are available on the MSA web Site or from the Secretary of the Meeting.

Autosolo

Driver Age / Vehicle Type - Road Legal / Passenger
14 – 15 / Touring Car / Passenger must be carried and must hold a Full RTA Licence.
16 / Touring Car / Optional Passenger, if carried must hold a Full RTA Licence.
17 and overwithout Full RTA licence / Touring Car / Optional Passenger, if carried must hold a Full RTA Licence.
17 and overwith Full RTA licence / Touring Car or Closed Car / Optional Passenger, minimum age 12 and must be over 135cm in height.
17 and overwith Full RTA licence / Open Car / Optional Passenger, minimum age 16
and must be over 135cm in height.

Production Car Autotest (PCA)

Driver Age / Vehicle Type / Passenger
14 -16 / Touring Car / Passenger must be carried and must hold a Full RTA Licence.
17 and over without Full RTA licence / Touring Car / Passenger must be carried and must hold a Full RTA Licence.
17 and overwith Full RTA licence / Touring Car or Closed Car / Passenger must be carried. Minimum age 12 and must be over 135cm in height.