Entry Form

(Please print off to fill in the form and send with your cheque to the address shown below. Many thanks)

DRIVER
Name ............................................................ Comp Lic. No. .........................
Address .................................................................................................
.........................................................................................................
.........................................................................................................
Tel no. (H) .................................... (B) ....................................................

CLUB ..............................................................................................

PASSENGER
Name ....................................................................................................

VEHICLE
Make ........................................... Model ..................................................
Reg No. .......................... CC ................................ Colour ...........................
Class Entered ................................. O/A Length ..............................................

Delete as appropriate: FWD . RWD . FERWD . RERWD . LSD

Driven Wheels
Rims: Dia ....................................... Width ..........................................
Tyres: Make ........................ Type ........................ Size ..........................

Diff: LSD YES/NO
Ratio: If non-standard state ratio or reply 'STD' .....................................

Please list all modifications to production form, or reply 'None'
....................................................................................

Engine Rebore: State size of rebore or reply 'No' ............................

IS THIS CAR BEING ENTERED BY ANOTHER DRIVER? YES/NO
If YES Who? ........................................................................

Please circle if contending any of the following championshLp or awards:
IF THIS IS NOT DONE IT WILL BE ASSUMED THAT YOU ARE NOT ELIGIBLE.

CHAMPIONSHIPS: RAC . BTRDA . ACSMC

AWARDS: NOVICE (see clause E.8.1.4) . LADIES . SOUTHERN

ENTRANTS/DRIVER’S SIGNATURE ..................................................

Nat 'B' Standard entry: £17.50
Nat 'B' Late Entry Surcharge: £2.50
Club Standard entry: £12.50
Club Late Entry surcharge: £2.50
Southern Car Club membership: £4.00
TOTAL: £ ...............................................

Please send fully completed form having signed the Declaration below, with your cheque/postal order made payable to Southern Car Club Ltd to:
Judith Weeks, 9 Manor Walk, Weybridge, Surrey, KT913 OSD

DECLARATION OF INDEMNITY

'I have read the Supplementary Regulations issued for this event and agree to be bound by them and by the General Regulations of The RAC Motor Sports Association Ltd. In consideration of the acceptance of this entry and of my being permitted to take part in this event, in respect of any parts of the event not held on a publicly adopted road, I agree to save harmless and keep indemnified The RAC Motor Sports Association Ltd, such Person, Persons or Body as may be authorised by The RAC Motor Sports Association Ltd to promote or organise this event and their respective Officers, Servants, Representatives and Agents together with other Competitors and their respective Servants, Representatives and Agents, from and against all actions, claims, costs, expenses and demands in respect of Death of or Injury to or Damage to the Property of myself, my Driver(s), Passenger(s), Mechanic(s) or associated personnel, arising out of or in connection with this entry or my taking part in this event.'

'State your age if you are under 18' ................................................

I declare that my car complies with the vehicle regulations appropriate to its class.

ENTRANT
Signature ............................... Age if under 18 ..........................

DRIVER
Signature ............................... Age if under 18 ..........................

PASSENGER
Signature ............................... Age if under 18 ..........................

Date: ...............................................................................

Please complete - in case of an Emergency on the day.

NEXT OF KIN

DRIVER
Name/Tel No. .......................................................................

PASSENGER
Name/Tel No. .......................................................................

If a competitor is under 18 years of age this form MUST be countersigned by an appropriate parent or guardian.

THIS ENTRY IS MADE WITH MY CONSENT
(BLOCK LETTERS PLEASE)

FOR DRIVER
Full name ..........................................................................
Relationship .......................................................................
Address ............................................................................ ........................................................................................
Tel No. ............................................................................

Signature ...........................................................................

FOR PASSENGER
Full name ..........................................................................
Relationship .......................................................................
Address ............................................................................ ........................................................................................
Tel No. ............................................................................

Signature ...........................................................................