COBRA CAR CLUB OF VICTORIA - DOC by pfe15066

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									                  AFFINITY LIMOUSINES

                                                            Presented by:

                           COBRA CAR CLUB OF VICTORIA INC
                                           21st March 2009
                                   WINTON RACEWAY Winton Victoria
                                           22nd March 2009
                              MOTOKHANA – Wangarratta Saleyards Wangarratta
                                   ENTRIES CLOSE Monday 2nd March 2009
COMPETITORS DETAILS
Name (Competitor 1)                                                                                                     M        F

Name (Competitor 2)                                                                                                     M        F
Address                                                                                           State                 P/Code


Contact Phone No.             Home :                          Mobile :                            Email :

VEHICLE DETAILS
MAKE / MODEL

ENGINE SIZE /
DETAILS
REGISTRATION No.

COMPETITOR ENTRY DETAILS AND COSTS
                         st
 SATURDAY SPRINTS on 21 March (Winton Raceway) (AASA)
                        nd
                                                                                                  $ 220.00                
 SUNDAY Motokhana on 22 March (Saleyards Wangarratta) (CAMS)
(Includes all meals Fri night, Sat night, Sun afternoon)
   Second Competitor                                                                             $ 220.00                
                                                       Competition Total $
                         Meals Total for NON COMPETITORS (refer next page) $
                                                              Grand Total $

Please forward your non refundable payment & entry form to:                     Enquiries - Tony Cram (03)9841 0274
                                                                                or mobile 0416 084 664
Cobra Car Club of Victoria                           Alternative Payment by Electronic Transfer to:
c/o 13 Cassowary Street                              Commonwealth Bank
                                                     Cobra Car Club of Victoria Inc.
Doncaster East VIC 3109 or                           BSB : 063 549
Email : tony_cram@huntsman.com                       A/C No. : 10356848
        atcram@bigpond.net.au                        (Please email receipt number details after transfer completed)
Late entry fee on the day (no exceptions) will incur an administration fee of $30.00 / Competitor
Motor Racing is dangerous. By signing this entry form you release and discharge the organisers, event sponsors, their members,
officers, directors, agents, employees, servants or anyone that is connected to or with the running of Shelby Fest from any and all
damages, losses, judgements and or claims suffered by an entrant and or partners and family, their person and or property.

I / We agree to abide by the Supplementary regulations of the event. Steward’s decisions are final on
the day. I / We have read and understand the terms and conditions of the event entry form.
Signed :                                                                                   Date
Signed :                                                                                   Date
               AFFINITY LIMOUSINES

                                            MEALS REGISTER
                     For non competitors please indicate how many meals you will be
                                attending. Children Under 12yrs are free.
                                                                                      No. OF PERSONS ATTENDING
                                                                                       (Please include competitors)
        DATE                              DESCRIPTION                                   We need to give numbers to
                                                                                               venues prior
      Friday                              Meet and Greet                                        No Charge
 20th March 2009                 Time: 5:00pm Pizza 6:00pm onwards
                                  Quality Hotel Wangarratta Gateway
                                          29 – 37 Ryley Street
                                          Wangarratta VIC 3677
                                           Ph: (03) 5721 8399
                                               No Charge
    Saturday                        Dinner and Presentations                             $35.00 per Non Competitor
 21stMarch 2009                              Time: 7:00pm
                                           To be announced
                              Cost per NON COMPETITOR $35.00 per person


        Sunday          Sunday Afternoon Presentation - Spit Roast                       $15.00 per Non Competitor
22nd    March 2009               At Merriwa Park after the Motokhana



                                                         Total Cost for meals        $
                                                         (Non Competitors)           Please add this to the entry details section


                                               ACCOMODATION
                                   PLEASE CALL THE HOTEL TO OOK YOUR ROOM
   We have reserved a number of rooms at the Quality Hotel Wangarratta or other accommodation is available nearby.
  To reserve your Accommodation please ring the Quality Hotel on the number below and confirm your booking. Please
            mention you are with the COBRA CAR CLUB OF VICTORIA to obtain a room and the special rate.

                                       Quality Hotel Wangarratta Gateway
                                               29 – 37 Ryley Street
                                              Wangarratta VIC 3677
                                              Phone: (03) 5721 8399
                                               Fax : (03) 5721 3879
                                        Info@wangarattagateway.com.au
                                        www.wangarattagateway.com.au

        ***** ENTRIES CLOSE Monday 2nd March 2009*****
PLEASE ENSURE YOU READ THE ATTACHED DISCALIMER FOR THE MOTORKHANA EVENT
                             ON SUNDAY AND SIGN
                         THIS IS FOR CAMS INSURANCE
 A MINIMUM OF A 2NS CAMS LICENCE WILL BE NEEDED FOR SUNDAY’S MOTORKHANA
  A DAY LICENCE WILL BE PROVIDED TO THOSE WHO DO NOT HAVE A CAMS LICENCE
                   AFFINITY LIMOUSINES

                                                           PRESENTED BY
                           COBRA CAR CLUB OF VICTORIA INC
                                            22nd March 2009
                               MOTOKHANA – Wangarratta Saleyards Wangarratta
        Held under the International Sporting Code of the FIA and the National Competition Rules of CAMS.
                                               Minimum Licence - Level 2NS

                                     ENTRIES CLOSE Monday 2 nd March 2009
COMPETITORS DETAILS
Name (Competitor 1)                                                                          CAMS Licence No :          M        F


Name (Competitor 2)                                                                          CAMS Licence No :          M        F


Address                                                                                      State                      P/Code




Contact Phone No.             Home :                         Mobile :                        Email :


VEHICLE DETAILS
MAKE
MODEL
REGISTRATION No.

Motor Racing is dangerous. By signing this entry form you release and discharge the organisers, event sponsors, their members,
officers, directors, agents, employees, servants or anyone that is connected to or with the running of Shelby Fest from any and all
damages, losses, judgments and or claims suffered by an entrant and or partners and family, their person and or property.

I / We agree to abide by the Supplementary regulations of the event. Stewards decisions are final on
the day. I / We have read and understand the terms and conditions of the event entry form.
Signed :                                                                                   Date
Signed :                                                                                   Date
                      PLEASE GO TO THE NEXT PAGE AND SIGN THE DISCLAIMER

OFFICE USE ONLY
Date Received      Signiture (Receiver)
                                                                                                   Version – February 2007
(For competitors and drivers in all competitions. This disclaimer must appear on all entry forms for every competition -
competitor is defined as the legal own er of the car)
                                                                      DISCLAIMER
                        EXCLUSION OF LIABILITY, RELEASE AND ASSUMPTION OF RISK
                                     COMPETITORS AND/OR DRIVERS
For Competitors
I/We being the competitor/s of the vehicle described on this Entry Form wish to enter that vehicle for the above event.
For Competitors and Drivers
I/We being the competitor/s and/or driver, certify that the particulars on this form are true and correct in every partic ular , to
the best of my/our knowledge and belief.
I/We declare that I/ we have read and understood the Supplementary Reg ulations 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 e ntering the event), I agree:
•         to releas e CAMS and Australian Motor Sport Commission Lt d, promoters, sponsor organisations, land owners
          and lessees, organisers of the event, their respective servants, officials, representatives and agents (collectively,
          the "Associated Enti ties") 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:

          •           motor vehicles (or parts of them) colliding with ot her 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.
I 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 understand that this disclaimer is not intended to exclude any valid claim I may have under the CAMS Personal
Insuranc e Scheme.

Competitor's signature: ....................................................    Date: ....................................... .

Driver/s signature: .........................................................   Date: ........................................

For persons under the age of 18 years the following parent/guardian consent must be completed.
                      PARENT/ GUARDIAN CONSENT – PERSONS UNDER 18 YEARS OLD

I …………………………………… 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.

    Signed…………………………………………………                                             Date…………………………………………………
           Parent/Guardian*
* Delete whichever does not apply

								
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