Docstoc

ing

Document Sample
ing Powered By Docstoc
					                                                                    Entry Form 2011
                                                                    MX1 - MX2
                                                                       RIDER
                                                     IS IMPORTANT TO FILL THE FORM ENTIRELY

NAME:                                                                         SURNAME:
DATE OF BIRTH:                                       NATIONALITY:
ADDRESS:
CITY:                                                        ZIP CODE:                                COUNTRY:
Email:
PHONE:                                                                               FAX:
MOTOCLUB:                                                                     COD. MOTOCLUB:
LICENCE:            FMN            FIM                LICENCE NUMBER:                                     Speciality:

ISSUED BY (indicate National Federation):

FOREIGN RIDERS: Are admitted those foreign riders holding a FIM Licence together with the Start Permission issued by their national Federation
    and those foreign riders holding a UEM member federation national licence together with the start permission issued by their national
                                                                federation.
                                                       BIKE/ CLASS/RACE NUMBER

MAKE:                                              CC.:                         STROKE:       2                         4

CLASS:        MX1
                                                                              Alternative Race
                                 Race Number
                                                                                  Number
              MX2
                                                                     CALENDAR
                 ROUND #1 PONTE A EGOLA (PI)                                  27/02/2011                                IMN:   291 / 007

                 ROUND #2 FAENZA (RA)                                           3/6/2011                                IMN:   291 / 011

                 ROUND #3 CINGOLI (MC)                                         3/13/2011                                IMN:   291 / 105

                 ROUND #4 GAZZANE DI PRESEGLIE (BS)                           27/03/2011                                IMN:   291 / 020
                                                                     ENTRY FEE

ENTIRE CHAMPIONSHIP ENTRY FEE                                                € 350.00

SINGLE ROUND REGISTRATION                                                    € 100.00

            The permanent registration fee must be regularised by cash before the beginning of the race or by postal order payable to:
                                "GSX - Iscrizioni Internazionali MX 2011", C.P. 73 - 55047 Querceta (LU)

                    Entry fee for a single round must be regularised ONLY on site before the beginning of the race.
                                                                        TEAM
TEAM:                                                                           CARD N°
TEAM MANAGER:
E-MAIL:
                                                                      PADDOCK
VEHICLE TYPE:                                                                 NUMBER PLATE:
LENGHT:                                                                       WIDTH:
STRUCTURES (tent, gazebo, ecc.):                                              MESURES:
TOT. (mq):                                                NOTE:

  Name                                                                          Name
 Surname                                                                       Surname




              Rider's Signature                                                  The parent or his/her stan-id (for the underge rider)

                                                 GSX srl Tel +39 0584.85229 - 85352; Fax +39 0584.85350
                                                             Web Site: www.offroadproracing.it



                                                                                                                                           pag. 1
                                                   Participants Responsibility et Liability
Responsibility
The participants (sponsors, riders, mechanics, signallers, passengers, owners and owner-drivers of vehicles, teams and all subjects in the staff) take
part in the event on their own risk. They bear the full responsibility, in each venue, for any civil and penal laws for damages suffered and/or caused
by them or by the vehicle they used during all the activities involving in the organization and the development of the event in question within the
limits of disclaimer provided in the Supplementary Regulations of the event.
Liability Waiver
1 - By submitting the entry form, the participants(sponsors, riders, mechanics, signallers, passengers, owners and owner-drivers of vehicles, teams
and all the subjects in their staff) waive all rights to legal action and recourse for any accident or damage incurred in conjunction during all the
activities involving the organization and the development of the event in question, against:
 - the UEM, the FIM, the FMNR, their presidents, members, employees, sporting stewards and other officials;
 - member-club of the FMNR and their organizers;
 - organizer/promoter, his/their representatives, stewards and assistants;
 - the owner(s) of the property used for the event including structures and installations on it, the administration of the circuit used for the event, their
representatives and assistants;
 - the participants and their attendants as well as against his/their own assistants;
 - authorities, race services and any other organization or corporate or natural bodies involved in all the activities relating to the organization and the
development of the event, within the limits of disclaimer provided in the Supplementary Regulations of the event.
2 - If the rider is not the owner of the vehicule used during the competition, the subscription of this form discharge the subjects mentioned above
from any responsibility and/or claim by the owner of the vehicle.
3 - By signing this entry form, this document is to be considered as a valid agreement and takes effects on all the parties involved.



(1) This Entry Form must be filled in each part,signed and sent (pag 1 and 2), to GSX Srl at fax nr +39 0584 85350 or sent at the email address
iscrizioni@offroadproracing.it, together with the proof of payment of the entry fee, in case of attending the entire championship;
(2) After the payment, please send the copy of the receipt to the Fax number +39 0584 85350
(3) The participation to the entire championship will be valid only after the payment settled and approved;
(4) For the confirmation of the registration you should control the web site www.offroadproracing.it, 3 working days after sending the entry form;
(5) Any variation of the above data must be promptly comunicated to GSX Srl;
(6) The full amount of registration is completely and exclusively responsibility of Motoclub, in case of non-participation, partial or total, will not be
refunded any amount
(7) The signature of this form implies knowledge and acceptance of Sporting Rules in force (FMI 2011 Motocross) and its Annexes and
Supplementary Rules for this year, as well as the Particular Regulation of the event.



   Place,                                                                                            Date:

  Name                                                                                              Name
 Surname                                                                                           Surname




                                                                                                              The parent or his/her stan-id
                        Rider's Signature                                                                          (for underage rider)


                                                     GSX srl Tel +39 0584.85229 - 85352; Fax +39 0584.85350
                                                                Website: www.offroadproracing.it


                                                                                                                                                       pag. 2

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:1
posted:9/26/2011
language:English
pages:2