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Bocchino Motors

FORMULA VEE NATIONAL CHALLENGE October 24th-25th 2009, Baskerville Raceway

*Displaying the Toll Shipping logo on your car is a condition of entry. Entrant (owner as in log book) CAMS Licence Number

Entrant’s Address Log Book Number

Home Phone

Work Phone

Mobile

Fax

Email Address

Driver Name CAMS Licence Number

Primary Sponsor In order to appear in the programme

Engine Capacity 1200cc / 1600cc / Historic (please circle)

Make of Car Colour of Car

Do you require a carport: Yes / No (please circle) Note that there are limited carports therefore first in first served.

Is your car arriving by Toll Shipping or TT-Line (please circle)

Entry Fee $350.00 $ Late Entry Fee $400.00 (after 12/10/09) $ Carport Hire $25.00 $ T-Shirts $35.00/shirt S ( ) / M ( ) / L ( ) / XL ( ) / XXL ( )

Write number required beside the relevant size. $

Cap $15.00/cap Total Number ( ) One size fits all $ Presentation Dinner $45.00 Total Number ( ) $

TOTAL $ Please make cheques payable to: The Formula Vee Association of Tasmania Post payment with entry form to: Pip Welch, 10 School Road, Sandford, Tasmania, 7020 Additional information regarding the race meeting will be sent out on receipt of entry.

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The meeting will be held under the International Sporting Code of the FIA, the National Competition Rules of CAMS Ltd and the Supplementary Regulations of the meeting of which this entry form is a part.

Entries Open: 7/08/09 Entries Close: 30/09/09 Dorian Transmitter Number:

Entrants’ Statement:

I/We being the entrant/s of the vehicle described on this entry form, wish to enter that vehicle for the above meeting. I/We certify that the particulars on this form are true and correct in every particular, to the best of my/our knowledge and belief. Entrant’s Signature___________________________ Date_______________________________________

Every entrant, team/c

Consent Statement for Persons under 18 Years: I, ________________________________________ being the parent/guardian of the above named driver have read the whole of this document and consent to him/her participating. In doing so, I acknowledge that Motor Sport is dangerous, and agree that neither CAMS Limited nor “The Organisers” shall be under any liability whatsoever for any death or bodily injury, loss or damage which may be sustained or incurred by this person or by me, howsoever such death or bodily injury, loss or damage is caused by negligence or otherwise.

Signed_________________________________________Date_________________ Parent/Guardian* Delete whichever does not apply. Date________________________________________________

Car Number:

Please note that entry form is three pages.

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DISCLAIMER

EXCLUSION OF LIABILITY, RELEASE AND ASSUMPTION OF RISK ENTRANTS AND/OR DRIVERS

For entrants I/We being the entrant/s of the vehicle described on this Entry Form wish to enter that vehicle for the above event. For entrants and Drivers I/We being the entrant/s and/or driver, certify that the particulars on this form are true and correct in every particular, to the best of my/our knowledge and belief. I/We declare that I/we have read and understood the Supplementary Regulations issued for the event, and agree to be bound by them and the provisions of the National Competition Rules of the Confederation of Australian Motor Sport Limited (“CAMS”). In exchange for being able to attend or participate in the event (including entering the event), I agree:

• to release 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/we acknowledge that:

• the risks associated with attending or participating in the event include the risk that I may suffer harm as a result of:

o motor vehicles (or parts of them) colliding with other motor vehicles, persons or property;

o acts of violence and other harmful acts (whether intentional or inadvertent) committed by persons attending or participating in the event; and

o the failure or unsuitability of facilities (including grand-stands, fences and guard rails) to ensure the safety of persons or property at the event.

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

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 CAMS and the Associated Entities. I/We understand that this disclaimer is not intended to exclude any valid claim I may have under the CAMS Personal Insurance Scheme. Entrant's signature: ........................................................ Date: ........................................ Driver/s signature: ......................................................... Date: ........................................

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Competition and targeted scrutiny history.

Date Venue of race meeting Audit 1* YES / NO 2. YES / NO 3. YES / NO 4. YES / NO 5. YES / NO Race meeting entered but not yet held.

YES / NO

*Most recent

Pit Crew covered by CAMS Personal Accident Insurance. Name (Print) Address Signature 1.

2.

3.

4.

END OF ENTRY FORM