2016Bathurst Motor Festival 6 Hour

Mt Panorama Motor Racing Circuit, Bathurst – Permit No: 816/2703/01

25th to 27thMarch 2016

/

Entry Form

/ This entry form must be read in Conjunction with the Meeting Supplementary Regulations of which it forms a part / Office Use

Held under the International Sporting Code of the FIA, the National Competition Rules and the Race Meeting Standing Regulations of Confederation of Australian Motor Sport Ltd(CAMS).

Entry Opening Date: 7th September 2015
Entry Closing Date: 19th February 2016
The fully completed Entry Form must be lodged with the Bathurst Motor Festival 6 Hour Administrator by the closing date with Entry Fees:
Michele Kidd
PO Box 421
Kings Langley NSW 2147 Australia
Competitor Details- (Owner of the vehicle as per the Log Book)
Team Name
Team Manager(Cannot be a Driver listed to Drive the Car) / Mobile Number
Sponsors Name
(40 characters max)
Address
(Incl Suburb)
Post/Zip Code / Country
Email
Mobile / Phone (Home)
ASN / Licence #
ASN eg CAMS, MSNZ etc
Vehicle Details
Make / Model
Year / Class / Capacity / Car No
ASN / Log Book #
ASN eg CAMS, MSNZ etc
Pit Lane Garage – 3 Vehicles per Garage (Will be on a shared basis 2 x 6hr, 1 x Production Sports)
Sharing with
Name and Car No
Corporate Suites
If interested in a Suite please advise Yes/No
In Car Camera– (Limited number of In Car TV Cameras available)
If interested in a In Car Camera please advise Yes/No
Driver 1 (A) Details
First Name / Surname
Date of Birth / Nationality
Address
(Incl Suburb)
Post/Zip Code / State
Email / Mobile
ASN / Licence #
ASN eg CAMS, MSNZ etc
Driver 2 (B) Details
First Name / Surname
Date of Birth / Nationality
Address
(Incl Suburb)
Post/Zip Code / State
Email / Mobile
ASN / Licence #
ASN eg CAMS,MSNZ etc
Driver 3 (C) Details
First Name / Surname
Date of Birth / Nationality
Address
(Incl Suburb)
Post/Zip Code / State
Email / Mobile
ASN / Licence #
ASN eg CAMS,MSNZ etc
DISCLAIMER
EXCLUSION OF LIABILITY, RELEASE AND ASSUMPTION OF RISKCOMPETITORS AND/OR DRIVERS, APPLICABLE TO ALL ROUNDS OF THE SERIES DETAILED ON THIS ENTRY FORM.
For Competitor
I/We being the competitor/s of the vehicle described on this Entry Form wish to enter that vehicle for the above event/s, and declare that the vehicle and all related equipment and components necessary for competition shall be presented, at all times and in every respect, in compliance with the CAMS National Competition Rules and Appendices and Schedules thereto, and to the event and vehicle regulations pertaining to the competition/s for which I have entered.
I further declare that I have caused the vehicle to be inspected according to a maintenance schedule that I have developed, and that it is free from mechanical defects, be they of design or structural integrity that may render the vehicle unsafe for competition.
I acknowledge that where any aspect of the car or related equipment and components is found:
- to be in breach of the NCR’s and/or the Regulations of the event, or;
- in the opinion of the Chief Scrutineer, to be subject to a serious mechanical defect,
it will render me in breach of NCR 144, and that I may be subject to penalties under the National Competition Rules.
My signature below indicates my acceptance of the above.
For Competitor and Drivers
I/We being the entrant and/or driver/s identified on this Entry Form, certify that the particulars on this form are true and correct in every particular, to the best of my/our knowledge and belief, and that we will notify the Category Manager if the details change at any time.
I/We declare that I/We have read and understood the Series Regulations issued for the event, and agree to be bound by them and the provisions of the National Competition Rules of the Confederation of Australian Motor Sport Limited (“CAMS”)
In exchange for being able to attend or participate in the event/s (including entering the event/s), I agree
  • to release CAMS and Australian Motor Sport Commission Ltd, promoters, sponsors, organisations, land owners and lessees, organisers of the event/s, their respective servants, officials, representatives and agents (collectively the “Associated Entities”) from all liability for my death, personal injury (including burns) psychological trauma, loss or damage (including property damage) (“harm”) howsoever arising from my participation in or attendance at the event/s, except to the extent prohibited by law.
  • that CAMS and the Associated Entities do not make any warranty, implied or express, that the event/s services will be provided with due care and skill or that any materials provided in connection with the services will be fit for the purpose for which they are supplied; and
  • to attend or participate in the event/s at my own risk.
I/We acknowledge that
  • the risks associated with attending or participating in the event/s include the risk that I may suffer harm as a result of:
•motor vehicles (or parts of them) colliding with other motor vehicles, persons or property;
•acts of violence and other harmful acts (whether intentional or inadvertent) committed by persons attending or participating in the event/s; and
•the failure or unsuitability of facilities (including grand-stands, fences and guard rails) to ensure the safety of persons or property at the event/s.
  • motor sport is dangerous and that accidents causing harm can and do happen and may happen to me.
I/we accept the conditions of, and acknowledge the risks arising from, attending or participating in the event/s and being provided with the event services by CAMS and the Associated Entities.I/We understand that this disclaimer is not intended to exclude any valid claim. I/We may have under the CAMS Personal Accident Scheme.
My/our signature/s below indicates my acceptance of the above.
For Driver/s.
I being the driver identified on this Entry Form, declare that
I have been fully briefed by the competitor on all aspects of the operation of the vehicle, including peculiarities relating to its handling and performance during competition; andI have satisfied myself that the vehicle is safe and suitable for the intended competition,
My signature below indicates my acceptance of the above, noting that if either party is changed, a new form must be signed & submitted.
Recent Competition and Scrutiny Audit History - Australian log booked Cars only
The Competitor must complete the following table showing the Competition and Scrutiny Audit history of the automobile described above for the last five Meetings as shown in the automobile Log Book. If at the time of completion of this declaration the automobile is entered into another Meeting yet to be held, please indicate in the space provided.
Date / Nature of Meeting / Venue / Scrutiny done? / Targeted Scrutiny Req’d?
/ Yes / No / Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Meeting entered but not yet held
COMPETITOR’S SIGNATURE…………………….……………………. Date……………………………………
DRIVER 1 SIGNATURE ….….…………………….………………….. DRIVER 2 SIGNATURE ….….…………………….…………………..
DRIVER 3 SIGNATURE ….….…………………….…………………..

PARENT/ GUARDIAN CONSENT – COMPETITOR / DRIVER UNDER 18 YEARS OF AGE

I …………………………………… of [Address] ……………………………………………………………………….. is the parent/ guardian* of the above-named ("the minor") who is under 18 years old. I have read this document and understand itscontents, including the exclusion of liability and assumption of risk, and have explained the contents to the minor. I consent to the minor attending/ participating in* the event/slisted at his/her own risk.

Signed…………………………………………………………… Date……………………………………

Parent/Guardian* (*Delete whichever does not apply)