HOW MUCH by lindash

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									SUNDAY MAY 22 2005
WESTERN SYDNEY INTERNATIONAL DRAGWAY, SYDNEY NSW

   RACING ENTRY FORM


 HOW                         DRAG RACING PRE ENTRY (closes May 18)

 MUCH?
                             VW Racing Driver and Car.............................................$55.00
                             Pit Crew and spectators...............................................At Cost $


Entrant Details:

Name:__________________________________Surname:_________________________________________________________

Address:_________________________________________________________________________________________________

Suburb/Town:_______________________________________State:____________________Postcode:_____________________

Email:________________________________________________.

Phone:(   )_______________________AH ________________________BH Mobile:_________________________________

ANDRA Licence Number:__________________________Drivers Licence Number:_____________________________________

Occupation:____________________________________________Car Club Name:_____________________________________


Vehicle Details:

Vehicle Make/Type___________________________________Engine Make/Capacity :________________________

                Registered (Please tick)
                                                           Gene Berg Trophy
                      Yes             No                          Yes               No

Year:________Rego:______________Colour:______________________

Sponsors:_____________________________________________________________________________________

_____________________________________________________________________________________________

Class Details:

             All VW
                                                                    OFFICE USE ONLY
                                                              RACE NO.              BRACKET
            Fastest 8 VW

                                 www.clubvw.org.au
                                                                 please turn over to read conditions and to sign the form.
EXCLUSION OF LIABILITY, RELEASE AND ASSUMPTION OF RISK - ENTRANTS/DRIVERS/RIDERS
I/We being the entrant/s and/or driver and/or rider, certify that the particulars on this entry 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 all the Supplementary Regulations issued for the event, and agree to be bound by them and the provisions of the
competition rules of the Australian National Drag Racing Association Inc (ANDRA).
In exchange for being able to enter, attend or participate in the event I/We aggree:
* to release ANDRA, promoters, sponsor organisations, land owners and lessees, organisers of the event, their respective servants, officials, representatives and
agents (colectively, 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 ANDRA and 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 materi-
als 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/our 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:
* motor vehicles (or parts of them) colliding with other motor vehicles, persons or property;
* acts of violence and other harmful acts (whether intentional or inadvertent) committed by persons attending or participating in the event; and
* the failure or unsuitability of facilities (including grand-stands, fences and guard rails) to ensure the safety of persons or property at the event.
* motor sport is dangerous and that accidents causing harm can and do happen and may happen to me/us.
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 ANDRA
and the Associated Entities.

Signature of Driver/Rider______________________________________________________Date:_________________________

Name of Entrant__________________________________________________________________________________________

Signature of Entrant._________________________________________________________Date:_________________________

Where the Driver/Rider is under the age of 18 years the following Parent/Guardian Consent must be completed:
PARENT/GUARDIAN CONSENT - PERSONS UNDER 18 YEARS OLD

I________________________________(print) of (address)________________________________________________________
am the parent/guardian* of the above-named (“the minor”) who is under 18 years old. I have read this document and understand its contents, including the exclusion
of liability and assumption of risk, and have explained the contents to the minor. I consent to the minor attending/participating in the event at his/her own risk.


Parent/Guardian* Signature:____________________________________Date______________*delete whichever does not apply


Pit Crew name: (please print)               Also note that ANDRA Licence Holders are allowed 3 pit crew, while other classes are allowed 1 pit crew)


1._____________________________________________Signature________________________________________________

2._____________________________________________Signature________________________________________________

3._____________________________________________Signature.________________________________________________


                                                                               NOTE: All crew members must be 18 years of age minimum, proof of age will be required.


Payment Details:

1. By Mail - Post your entry form and cheque/money order or cash made payable to Club Vee Dub Sydney

                                        Cl - 11 Greenlands Ave Peakhurst NSW 2210

Scrutineer’s Use Only:

Weight:________________________Comments______________________________________________________
                                                                                                                                        No.
Scrutineer/Classifier Name:_________________________________________________

Signature:___________________________________________Date:_______________

What to bring: Drivers licence, registration and CTP insurance paperwork, ANDRA licence (if required), ANDRA tech inspection paperwork (if required),
ANDRA approved helmet, long pants, long sleeve shirt, shoes & socks. NOTE: Vehicles that run quicker than 11.99 seconds are required to purchase an
ANDRA Super Street licence ($110) on the day. Quicker than 10.99 require an ANDRA tech inspection and a licence upgrade to UDL ($220).


       Club Vee Dub Sydney - Contact David Birchall 9534 - 4825 or 8304 - 4109

								
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