GUERNSEY KART & MOTOR CLUB LBG - 2016 CAR ENTRY FORM

RACE MEETING
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HILL CLIMB
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SPRINT
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Please Tick Box

VENUE DATE OF EVENT

Held Under the General Regulations of The Motor Sports Association (incorporating the provisions of the International Sporting Code of the FIA) and these Supplementary Regulations

l. I declare that I have been given the opportunity to read the General Regulations of the Motor Sports Association and, if any, the Supplementary Regulations for this event and agree to be bound by them. I declare that I am physically and mentally fit to take part in the event and I am competent to do so. I acknowledge that I understand the nature and type of the competition and the potential risk inherent with motor sport and agree to accept that risk.

2. I declare that to the best of my belief the driver(s) possess(es) the standard of competence necessary for an event of the type to which this entry relates and that the vehicle entered is suitable and road worthy for the event having regard to the course and the speeds which will be reached.

3. Any application for a Licence which was signed by a person under the age of 18 years was countersigned by that person's parent/legal guardian/guarantor whose full names and addresses have been given.

4. If I am the Parent/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.’

Note: Where the Parent is not present there must be a Guardian who must produce a written and signed authorisation from the Parent/Guardian to act as their representative

5. I understand that should I at the time of this event be suffering from any disability whether permanent or temporary which is likely to affect prejudicially my normal control of my vehicle, I may not take part unless I have declared such disability to the ASN which has, following such declaration, issued a licence which permits me to do so.

6. I undertake that at the time of the event to which this entry relates I shall have passed or am exempt from an ASN specified medical examination within the specified period.’ (H.10.1.6)

PLEASE WRITE IN BLOCK LETTERS

DRIVERS NAME AGE IF UNDER 18 YEARS

COMP. LICENCE TYPE & NO. PG LICENCE NO. (if under 18)

ADDRESS

DETAILS OF KART: MAKE MODEL

CUBIC CAPACITY ______RESTRICTED (NOVICE) Y/N

COMPETITION NO.

CLASS TO BE ENTERED

PROGRAMME ENTRY DETAIL _

CLASS NUMBER TO BE ENTERED AS LISTED IN SUPPLEMENTARY REGS (See Over Page) ______

ENTRY FEE : CASH CHEQUE ______MEMBERSHIP NO. .

SIGNATURE ______TEL NO. DATE

NAME OF CONTACT IN CASE OF EMERGENCY ______TEL NO. ______

To be completed by Parent or Guardian if driver is under 18 years of age

_I______(full name) ADDRESS ______

______

BEING ______(relationship) TO THE ABOVE NAMED DRIVER, CONFIRM THAT THE

ENTRY IS MADE WITH MY CONSENT

SIGNED ______DATE ______

Please send the completed entry form plus payment to:- Competition Secretary: Mrs Heather Robilliard A’Jamais,

6 Hougues Magues Lane, Capelles, St Sampsons, Guernsey GY2 4WA - Tel: 01481 247892

The event will consist of the following classes:
1 / Road Going Series Production Cars up to 2000cc complying cars with (S) 11
2 / Road Going Series Production Cars 2001cc & over complying cars with (S) 11
3 / Modified Limited Production Cars up to 1400cc complying cars with (S) 12
4 / Modified Limited Production Cars 1401cc to 1800cc complying cars with (S) 12
5 / Modified Limited Production Cars 1801cc & over complying cars with (S) 12
6 / Modified Specialist Production Cars up to 1400cc complying cars with (S) 12
7 / Modified Specialist Production Cars 1401cc to 1800cc complying cars with (S) 12
8 / Modified Specialist Production Cars 1801cc & over complying cars with (S) 12
9 / Sports Libra Saloons up to 1400cc complying cars with (S)14
10 / Sports Libra Saloons 1401cc to 1800cc complying cars with (S)14
11 / Sports Libra Saloons 1801cc and over complying cars with (S)14
12 / Sports Libre Saloon Rally Cars up to 1600cc complying cars with (S)14 & (R) 46.1 to 48.10.10 Note 7
13 / Sports Libre Saloon Rally Cars 1601cc & over complying cars with (S)14 & (R) 46.1 to 48.10.10 Note 7
14 / Sports Libre up to 1600cc complying cars with (S) 14
15 / Sports Libre 1601cc to 2000cc complying cars with (S) 14
16 / Sports Libre 2000cc & over complying cars with (S) 14
17 / Sports Libre G up to 1400cc complying with (S) 14
18 / Sports Libre G 1401cc to 1800cc complying with (S) 14
19 / Sports Libre G 1801cc and over complying with (S) 14
20 / Racing Cars up to 600cc complying cars with (S) 15
21 / Racing Cars 601cc to 1100cc complying cars with (S) 15
22 / Racing Cars 1101cc to 1600cc complying cars with (S) 15
23 / Racing Cars 1601cc to 2000cc complying cars with (S) 15
24 / Racing Cars 2001cc & over complying cars with (S) 15
25 / Non transaxle Specials unlimited complying cars with (S) 15 Note 1
26 / Historic Cars manufactured before 31/12/1967 Note 2
27 / Post Historic Cars manufactured before 31/12/1979 Note 2
28 / Standard Sand Race Saloons unlimited Note 3, 4, & 6
29 / Modified Sand Race Saloons unlimited Note 3, 4, & 6
30 / Special Sand Race Saloons & 4 Wheel Drive unlimited Note 3, 4 & 6
31 / Road Going Specialist Production Cars up to 1400 complying cars with (S) 11
32 / Road Going Specialist Production Cars 1401 to 1800 complying cars with (S) 11
33 / Road Going Specialist Production Cars 1801 & over complying cars with (S) 11
Note 1 / Run to Racing Car Regs Transaxle not permitted
Note 2 / Only period modifications will be permitted and the use of slick tyres is prohibited.
Note 3 / Must Have Roll Cage
Note 4 / Regs Section N Complying with Section J Safety section S10 MSA Yearbook 2016
Note 5 / Wheels & Tyres Free
Note 6 / Must comply with N4.10 MSA Yeartbook 2016
Note 7 / Exempt from date restrictions of 48.10.4 & 48.10.6 MSA Yearbook 2016