US CAR SALE- SOUTHERN DRAG RACE 2013

On 23rd of February 2013 Organized by: SOUTHERN MOTOR SPORTS CLUB

CLUB EVENT

ENTRY FORM

Entries accepted at: 1. WHEELS LANKA,215, Galle Road, Pamburana, Matara. Tel. 2224222, 2226222: Fax. 041-2231606 2.Marble Dcornd., 175, Nawala Road, Nugegoda, Tel. 011-7254455,5765665 Fax; 011-2817955 3. Premadasa Group of Companies, 179, Jayantha Weerasekera Mw., Col. 10. Tel. 011-2436994 | Fax. 011-2449950 th th Entries open on: 28 January 2013 at 10.00 am. Entries close on:20 February 2013 at 5.00 pm. COMPETITORS NAME: .. .... (surname) (other names) AGE: SLAS COMPETITION LICENSE NO (for motor car competitors) IF ANY FMCSSLCOMPETITION LICENSE NO (for motor cycle competitors) IF ANY DRIVING/RIDING LICENCE NO .. BLOOD GROUP.

POSTAL ADDRESS:. E-MAIL.....

TELEPHONE NO. ... . . (OFFICE) (RESIDENCE) (MOBILE) (FAX) ARE YOU A MEMBER OF SMSC/YSMSC: YES/NO IF YES, MEMBERSHIP NO. .

Description of the competing Event (tick the appropriate box)

MOTOR CYCLES
1 Motor Cycles up to 250 CC 3. Motor Cycles over 601 CC 2. Motor Cycles above 250 and up to 600 CC

MOTOR CARS
4. Cars upto 1000cc N/A 5. Cars over 1001cc up to 1300cc N/A 6. Cars over 1301cc up to 1500cc N/A 7. Cars over 1501cc up to 1600cc N/A 8. Cars over 1601cc up to 2200cc N/A 9. Cars up to 1600cc turbo open 10. Cars up to 3500cc AWD Stock Turbo N/A Normally Aspirated

OFFICE USE ONLY Comp. No .. Class .. Receipt No. Rs. __________________ Cash / Cheque

Description of the competing vehicle**:

Make Year Manufactured Engine No. Engine C.C. No. of Doors 2/3/4/5 Model Registration No. Chassis No. Super/Turbo Charged Body Type YES / NO Sedan/H'Back/S'Wagon

Rotary Engine YES / NO **Documentary evidence of information furnished by the manufacturer should be submitted

Participating Events * (class) (within Major Events) (each Competitor is allowed to enter a maximum of five events): 1 2 (* for events, see section 4 in Supplementary Regulations) INDEMNIFICATION: It is a condition of entering a vehicle for this meet and of driving or riding in or attending upon any vehicle so entered, that the person or persons so driving or riding it or attending upon it, do agree that the Southern Motor Sports Club or any official, agent or servant thereof shall, in any circumstances whatever, be liable for any damage to or done by the said vehicle or for any other person injured or loss of what ever kind sustained by the driver or mechanics or other persons driving, riding in or attending upon the said vehicle, whether caused during any race or during any practice run, or while the said vehicle is on any road forming part of the race course or any approach thereto or land adjacent thereto, by wilful act, negligence or default of any official agents or servants of the said Club, Organisers, Persons or Concerns. And it is further a condition that no driver or other person or persons as aforesaid shall participate in the Meet without having first satisfied himself as to the safety and suitability in all respects of the course, and that the said person or firm so entering the vehicle agrees to indemnify the said Club, persons or concerns and their official agents and servants against all liability for any damage, injury or loss done or sustained as aforesaid by the driver or such other persons. More over, all riders participating in this meet are required to obtain, Personal Accident Insurance Cover. Declaration: I undertake to adhere to and be bound by the Rules, Regulations, Supplementary Rules, and Instructions governing the Meet, which Rules, Regulations and Instructions I have read and understood. I undertake to adhere to the decisions of the Organising Committee which has the right to accept or reject an Entry and whose decision is final and binding without assigning any reasons whatsoever. I further declare that all information given in this form is true and correct and any information is found to be incorrect, I agree to abide by the disciplinary action taken by the Southern Motor Sports Club.

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Signature

Name

Date

Payments:

Entry Fees Motor Cars Motor Cycles Members 3,500/= 1,500/= Non Members 4,500/= 2,500/=

TOTAL PAYMENT

Rs.. - Cheque No. Bank. .)

(Paid by - Cash / Cheque: