2014 SHANNONS AUSTRALIAN MOTOR RACING NATIONALS

Round 7 – Phillip Island

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[Office Use]

Entry Confirmation

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This entry must be read in Conjunction with the Meeting and Further

Supplementary Regulations of which it forms a part.

PHILLIP ISLAND AUTO RACING CLUB LTD
ABN 90 004 351 446 /
PHILLIP ISLAND GRAND PRIX CIRCUIT
19th – 21st September 2014

Held under the International Sporting Code of the FIA and the National Competition Rules of Confederation of Australian Motor Sport Limited (CAMS) and all regulations issued for the Meeting. This form is for confirmation of entry for the above Meeting, as made on the Series Entry Form prior to commencing competition in the Series/Event

PLEASE COMPLETE AND RETURN TO CATEGORY MANAGER……………
Please send to:
Tri-State Racing Pty Ltd Post: 6 Williams Avenue, Glenelg East SA 5045
Fax:08 8294 1583 Scan & Email to:

ENTRY CONFIRMATION Part A

Competitor’s declaration (to be completed):

I, ………………………………………………………………, being the competitor of the car listed above, in the above Series, wish to confirm my entry in the above Meeting, and that the details and declarations previously submitted on the Entry Form remain true and all event applicable fees have been paid.

Please tick the days you will be attending the circuit Friday . Saturday . Sunday ..

Competitor’s signature ………………………..………………………………………………………… Date ………………………………………………….

GARAGES: We prefer to share with:

SCRUTINY Part B

Recent Competition and Scrutiny Audit History

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? / Mandatory Scrutiny?
/ Yes / No / Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Meetings entered but not yet held

PIT LANE DISCLAIMER Part C

PHILLIP ISLAND Friday 19th to Sunday 21st September 2014

PHILLIP ISLAND AUTO RACING CLUB LTD

ABN 90 004 351 446

PIT LANE DISCLAIMER

EXCLUSION OF LIABILITY, RELEASE AND ASSUMPTION OF RISK

In exchange for being able to attend or participate in the event, I agree:

•  to release Confederation of Australian Motor Sport Ltd ("CAMS") and Australian Motor Sport Commission Ltd, promoters, sponsor organisations, land owners and lessees, organisers of the event, 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, except to the extent prohibited by law;

•  that CAMS and the Associated Entities do not make any warranty, implied or express, that the event 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 at my own risk.

I acknowledge that:

•  the risks associated with attending or participating in the event 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; 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.

•  motor sport is dangerous and that accidents causing harm can and do happen and may happen to me.

I accept the conditions of, and acknowledge the risks arising from, attending or participating in the event and being provided with the event services by CAMS and the Associated Entities.

Pit Crew Names
(Please print clearly) / Pit Crew Signatures / Dates of Birth / Addresses
Name: / Signed: / Date of Birth:
Name: / Signed: / Date of Birth:
Name: / Signed: / Date of Birth:
Name: / Signed: / Date of Birth:
Name: / Signed: / Date of Birth:
Name: / Signed: / Date of Birth:

I……………………………………………………………….…, being the Competitor or his/her agent, of Car No………. in the Australian V8 Touring Car Series declare that the persons whose names and signatures appear above are attached to my team.

Signature Date .

For persons under the age of 18 years parent/guardian consent must also be completed.

PARENT/ GUARDIAN CONSENT – PIT CREW UNDER 18 YEARS OLD

I …………………………………… of [Address] ……………………………………………………………………….. am the parent/ guardian* of the above-named ("the minor") who is under 18 years old. I have read this document and understand its contents, 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/s listed at his/her own risk.

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

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

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