SOUTHERN SUPERMOTO RACE ENTRY FORM

ROUND: ……………………………………………………… Venue: ……………………………………………………… Date of Event: …………………………………………………………

This event is held under SSM.UK Standing Regulations, Championship Conditions and any Final Instructions issued for the meeting.

Entry declaration: 

I / we the undersigned apply to enter the event described above and in consideration thereof:-
• I / we hereby declare that I / we have had the opportunity to read, and that I / we understand the SSM.UK Standing Regulations, such Championship Conditions as have or may be issued for the event, and agree to be bound by them.
• I / we further declare that I am / we are physically and mentally fit to take part in the event and I am / we are competent to do so.
• I / we confirm that I / we understand the nature and type of event we are entering and its inherent risks and agree to accept the same notwithstanding that such risks may involve negligence on the part of the organisers or officials.
• I / we confirm that the machine(s) as described below which I / we compete on shall be suitable and proper for the purpose.
• I / we agree that I am / we are required to register our arrival by “signing on” at the designated place not less than 30 minutes prior to commencement of my/our practice or first competition, whichever occurs first.
• I / we enclose the entry fee of: £70.00/£85.00 (£85.00 is required for 1st race at Lydd)

Acknowledgement of the risks of motorsport: I / we understand that by taking part in this event I / we are exposed to a risk of death, becoming permanently disabled or suffering some other serious injury and I / we acknowledge that even in the event that negligence on the part of SSM.UK the AMCA, the venue owner, or any individual carrying out duties on their behalf were to be a contributory cause of any serious injury I / we may suffer, the dominant cause of any serious injury will always be my / our voluntary decision to take part in a high risk activity.

I / we have read the above and acknowledge that my / our participation in motorsport is entirely at my / our own risk.

Rider’s signature: ……………………………………………………………… If under 18 state date of birth*: …………………………………………………

* For riders under 18 years of age - I accept the above conditions of entry to this event and give my approval:

Signature of parent or person with parental responsibility:…………………………………………………………………………

Please note that Proof of Age may be required at “signing on”

RIDER Surname: ……………………………………………………………………      Machine………………………

First name(s): …………………………………………………………………………    Capacity……………cc

Address: ………………………………………………………                 Make:…………………………… …………………………………………… Class ……………………

Postcode: ……………………………… Tel: ……………………………………     AMCA Licence No: ………………………………………………………………

Name of Affiliated Club…………………………………………………(of which I am a member):

I would like to enter the following Class (tick box to indicate)
Youth 85 ( ) 125/250 ( ) Novice ( ) Intermediate ( ) Expert ( )