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English (UK)
14th PAUL KILBAUSKAS MEMORIAL TRIAL - 2022
Promoted by the Inverness & District Motor Cycle Club on Sunday, September 4th 2022 to be held on Alvie Estate, Kincraig. A round of the SACU Scottish Trial Championships 2022 - (SACU Permit No: 02465)
Name
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First Name
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Club
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Club
IDMCC member entering must provide an observer.
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Status (Please select one only)
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Expert
Non-Expert
Novice
Youth Rider
SACU/ACU/MCUI Licence/Card Number
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Machine & CC
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Machine
CC
E-mail address
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please double check as all correspondence is sent by e-mail
Class (Select one only)
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Class 1 - Premier (Red Route)
Class 2 - Sportsman (Blue Route)
Class 3 - Clubman (Green Route)
Class 4 - Over 40 Sportsman (Blue Route)
Class 5 - Over 40 Clubman (Green Route)
Class 6 - Over 50 (Green Route)
Class 7 - Adult C (Yellow Route)
Class 8 - Youth A (Blue Route)
Class 9 - Youth B (Green Route)
Class 10 - Youth C (Yellow Route)
Class 11 - Youth D (Yellow Route)
Class 12 - Youth D 50:50 Intermediate
Class 13 - Youth E (E Route)
I wish Championship points awarded for this event
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Yes
No
Address Details
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Street Address Line 2
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Postal Code
Date of Birth (Only if Under 18 Years of Age)
DDMMYYYY
Home Number (Inc. STD code)
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Declaration:
I the undersigned apply to enter the event described above in the consideration of: 1. I hereby declare that I have had the opportunity to read, and that I understand the National Sporting Code of the ACU/SACU, the ACU/SACU standing regulations, such Supplementary Regulations as may have been issued for the event, and agree to be bound by them. 2. I further declare that I am physically and mentally fit to take part in the event am I am competent to do so. 3. I confirm that I understand the nature and type of event I are entering and its inherent risk and agree to accept the same notwithstanding that such risks may involve negligence on the part of the organisers or officials. 4. I accept that insurance arranged on my behalf by the organisers of events that I may enter specifically excludes liability between the participants. I understand that this form may be used in litigation as evidence that any serious injury will be principally the result of my voluntary decision to engage in high risk activity. 5. I consent to details of any injuries I may suffer at this event being passed between all medical services and the Clerk of the Course/Secretary of the Meeting. 6. I further agree that the machine(s) as described below which I compete on shall be suitable and proper for the purpose. 7. I confirm that if any part of the event takes place on a public highway, the machine(s) described overleaf shall be insured as required by the Road Traffic Acts, or equivalent legislation, and that it/they will comply with the regulations in respect thereof. 8. I understand and agree that I am required to register my arrival by signing on at the race control office or other designated area, not less than 30 minutes prior to commencement of my practice or first competition, whichever occurs first. 9. I confirm that I have not been refused a SACU/ACU Licence, nor had a SACU/ACU Licence suspended, nor have I been excluded from any SACU/ACU competition. 10. I confirm that I am not currently suspended from SACU/ACU competition, or on the ACU/SACU Stop List as a result of incurring a Concussion injury. Further, I shall notify the Club should I incur such a suspension or concussion injury between now and the event. Acknowledgement of the Risks of Motorsport: I understand that by taking part in this event I am are exposed to a risk of death, becoming permanently disabled, or suffering some other serious injury and I acknowledge that even in the event that negligence on the part of the ACU/SACU; the Promoter; the organising Club; The Inverness & District Motor Cycle Club Ltd; the venue owner; or any individual carrying out duties on their behalf were to be a contributory cause of any serious injury I may suffer, the dominant cause of any serious injury will always be my voluntary decision to take part in a high risk activity. I have read the above and acknowledge that my participation in motorsport is entirely at my own risk. I submit my entry fee of £28.00 (Adult)/£18.00 (Youth).
Competitor's Signature (use cursor or finger) This confirms that you agree to the Supplementary Regulations and the Declaration (above).
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Under 18 entrant's Parent/Guardian Signature (use cursor or finger) This confirms that you agree to the Supplementary Regulations and the Declaration (above).
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Signature(s) Date
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Entry Fee Payable (Select one only, then make payment through PayPal (Paypal or Debit/Credit card) and then submit application below)
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Adult Entry Fee
£
28.00
Youth Entry Fee
£
18.00
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