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Enduro Champs Friday Practice Entry Form

Sydney Motorsport Park Friday 5th March 2021

Please complete the form below to enter the Enduro Champs Friday Practice

Entrant
Entrant First Name*
Entrant Last Name*
Entrant Mobile No.*
Entrant Email*
Entrant Address*
Street Address Address Line 2 City State Post Code
Entrant Emergency Contact Name*
Entrant Emergency Contact Number*
Entrant CAMS/AASA/RACERS License No.*
Entrant License Expiry*
Date Format: DD slash MM slash YYYY
Is the entrant also the driver?*
- Yes
- No
Would you like to add a 2nd driver?*
- Yes
- No
Driver Details
First Name*
Last Name*
Mobile No.*
Email*
Address*
Street Address Address Line 2 City State Post Code
Emergency Contact Name*
Emergency Contact Number*
CAMS/AASA/RACERS License No.*
License Expiry*
Date Format: DD slash MM slash YYYY
Would you like to add a 2nd driver?*
- Yes
- No
Additional Driver
2nd Driver First Name*
2nd Driver Last Name*
Mobile No.*
Email*
Address*
Street Address Address Line 2 City State Post Code
AASA or CAMS Licence Number*
Expiry Date*
Date Format: DD slash MM slash YYYY
Emergency Contact Name*
Emergency Contact Number*
Would you like to add a 3rd driver?*
- Yes
- No
3rd Driver
3rd Driver First Name*
3rd Driver Last Name*
Mobile No.*
Email*
Address*
Street Address Address Line 2 City State Post Code
AASA or CAMS Licence Number*
Expiry Date*
Date Format: DD slash MM slash YYYY
Emergency Contact Name*
Emergency Contact Number*
Racecar Details
Year of Racecar*
Make*
Model*
Colour*
1st & 2nd Preferred Race Number*
Capacity*
Dorian Number
Log Book Number*
Pit Crew
PLEASE NOTE: With respect to how many crew are allowed to support each race car under the Covid requirements, we will make a final determination closer to the event which will be based on advice from NSW Health in consultation with SMP management (as the venue operator). We ask that you keep your manning to a minimum and please list them below with full name and phone no. This will also give us an idea as to how many we would like to have onsite but stress, final confirmation of how many are allowed will be determined closer to the event.
Pit Crew
Terms & Conditions / Disease Exclusion
COMMUNICABLE DISEASE EXCLUSION

1. Notwithstanding any provision to the contrary within this policy, this policy does not cover all actual or alleged loss, liability, damage, compensation, injury, sickness, disease, death, medical payment, defence cost, cost, expense or any other amount, directly or indirectly and regardless of any other cause contributing concurrently or in any sequence, originating from, caused by, arising out of, contributed to by, resulting from, or otherwise in connection with a Communicable Disease or the fear or threat (whether actual or perceived) of a Communicable Disease.

2. For the purposes of this endorsement, loss, liability, damage, compensation, injury, sickness, disease, death, medical payment, defence cost, cost, expense or any other amount, includes, but is not limited to, any cost to clean-up, detoxify, remove, monitor or test for a Communicable Disease.

3. As used herein, a Communicable Disease means any disease which can be transmitted by means of any substance or agent from any organism to another organism where:

3.1. the substance or agent includes, but is not limited to, a virus, bacterium, parasite or other organism or any variation thereof, whether deemed living or not, and

3.2. the method of transmission, whether direct or indirect, includes but is not limited to, airborne transmission, bodily fluid transmission, transmission from or to any surface or object, solid, liquid or gas or between organisms, and

3.3. the disease, substance or agent can cause or threaten bodily injury, illness, emotional distress, damage to human health, human welfare or property damage.
Acceptance of Disease Exclusion*
- I accept I/We have read the above disease exclusion.
"I/We have read and understood the Supplementary Regulations issued for this Meeting and agree to be bound by them and by the National Competition Rules of the Australian Auto-Sport Alliance Pty. Ltd. (AASA) I/We also acknowledge and agree that neither Australian Auto-Sport Alliance Pty. Ltd., nor Benalla Auto Club Pty. Ltd., nor the sponsor organisations, nor the land owners or lessees, nor the organisers of the race meeting/ event, nor their respective servants, officials, representatives or agents (all of whom shall collectively be called "the Organisers"), shall be under any liability for my death, or any bodily injury, loss or damage which may be sustained or incurred by me, as a result of participation in or being present at the event, except in regard to any rights I may have arising under the Trade Practices Act 1974. I/We acknowledge that motor sport is dangerous and accidents causing death, bodily injury, disability and property damage can, and do, happen. I/We accept the conditions of, and acknowledge the risks arising from, attending or participating in the event and being provided with the event services by AASA and the Associated Entities.
Acceptance of Terms & Conditions*
- I accept I/We have read the above terms and conditions.
Payment
Enduro Champs Friday Practice*
Price: $ 242.00
AMRS Rd 1 - Booking Fee*
Price: $ 5.00
AMRS Rd 1 - Enduro Champs Friday Practice
Includes GST
$ 0.00
Credit Card

Card Details

Cardholder Name

driveagainstdepression

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