Car Rally 2010

In respect of any parts of this event on ground where third party insurance is not required by the law this agreement shall in addition to the parties named above extend to all and any other competitor/s and their servants and agents and to all actions, claims, costs, expenses and demands in respect of loss or damage to person or property of myself, my driver(s), passengers(s) or mechanic(s) but shall not extend to a competitor adjudged guilty of reckless driving under the same General Competition Rules.

In the case of any event taking place wholly or partly on the public roadway: “I declare that the use of the vehicle hereby entered will be covered by Insurance and required by the law which is valid for such part of this event as shall take place on roads as defined by the law.

Any vehicle five years and over and relevant stickers attached to windscreen in accordance to the law.
 

CAR REG. NO

MAKE 

MODEL

DRIVER NAME    NAVIGATOR NAME
ADDRESS ADDRESS
PHONE NO PHONE NO
BLOOD GROUP BLOOD GROUP
SIGNATURE   SIGNATURE  
................................................................................................. ...................................................................................................
EMAIL   EMAIL
   
NB: SIGNATURE OF GUARDIAN NEEDED IF COMPETITOR IS UNDER 18 YEARS OLD

NAME  OF GUARDIAN

SIGNATURE OF GUARDIAN

......................................................................

EMERGENCY CONTACT INFORMATION
EMERGENCY CONTACT NAME

CONTACT NO.

CATEGORY          
Nov-Ex Cooperate  

OPEN NOVICE

  All Female
NAME OF TEAM

SPONSORED BY:


ENTRY FEE $100.00
 


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Form Designed  for Hutt Shutts Car Rally by: George Livingstone - Sept 2010

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