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round 3 NEEC ACU time card
ACU Time Card Event Registration
Name
(Required)
First
Last
Email
(Required)
Race Number/Number On Bike
Race Class
(Required)
Championship
Expert
Clubman
Sportsman
Vets 40+
Vets 50+
Vets 60+
Youth 14-16
Emergency Contact
(Required)
First Name
Last Name
Emergency Contact Phone Number
(Required)
ACU LICENCE
Please enter your licence number. Unless you should require a day licence on the day. This incurs an extra cost of £20 on the day.
Billing Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
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Australia
Austria
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Bosnia and Herzegovina
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Cook Islands
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Korea, Republic of
Kuwait
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Nigeria
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Norway
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Panama
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Poland
Portugal
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Sweden
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Thailand
Timor-Leste
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United Kingdom
United States
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Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Credit Card
Card Details
Cardholder Name
NEEC Round 3 June 15th Entry Fee
Price:
Consent
(Required)
Conditions of Entry:
Declaration
· In consideration of being permitted to participate in this event I declare that I will be bound by the declaration on the event entry form.
· I also acknowledge and accept the Risks of Motorsport as shown on the said entry form.
· I have read and understood The Auto Cycle Union Ltd Data Protection Policy and I consent to the collection and retention of my personal information by the ACU.
· I give permission for details of any injuries I may suffer during this event to be given to the Clerk of the Course.
· I/we confirm that I/we are eligible to compete on the machines for which I/we have entered.
· I/we confirm that I/we are not suspended or my/our ACU Licence has not been suspended/withdrawn from any ACU competition.
· I confirm that I am physically and mentally able to participate and am competent to do so.
· I confirm that I am not currently suspended from ACU permitted competition or on the ACU Stop List as a result of incurring a Concussion injury.
Acknowledgement of the risks of motorsport
I understand that by taking part in this event I am 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, any event organiser, any circuit owner, the promoter, the organising club, 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 agree to the following terms and conditions.
Enduro Gallery
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