ONLY FULLY COMPLETED FORMS WILL BE CONSIDERED

 

George Peach,  Race Secretary,

Ellerslie, 128 Malew Street,

CASTLETOWN, Isle of Man.IM9 1LT

Tel. 01624 822546 (H)  07624 471301(M)

Email: georgepeach@manx.net

 

10-

 

2010 Steam Packet Southern 100 Road Races

Billown Circuit, Castletown, Isle of Man.

An International Status Competition

On Monday to Thursday 12th to 15th July.

Held under the National Sporting Code (4th Edition) and the 2010 Standing Regulations of the Auto-Cycle Union. Together with the Supplementary Regulations of Southern 100 Motor Cycle Racing Ltd. and Final Instructions to be issued.  PCL 028                                       Permit ACU 27718     Permit IMN 191/073

Official Entry Form

RIDER/PILOTE                                                        

First Name(s)/Prĕnom­­­­­­­­­­­­­________________________________Surname/Nom______________________________

 

Address_____________________________________________________________________________________

 

Town_______________________County_________________Country________       Post Code_____________

 

Tel. No ­­­­­­­­­­­­­­­­­­­­­­­­­­___________________Mob. No.__________________        Licence No._____________________

 

Date of Birth D/M/Y ____/_____/____ Nationality_________________ Marital Status_______________

Name of                                                  

Next of Kin________________Spouse/Partner/etc.__________          No. of Children(State Ages)_____________

 

Next of Kin Address____________________________________________________________________________

 

_______________________________Tel No.(day) ___________________(evening)________________________

 

Isle of Man Address___________________________________________________________________

____________________________________IOM Tel No._______________________________

PASSENGER

First Name(s)/Prĕnom­­­­­­­­­­­­­________________________________Surname/Nom______________________________

 

Address__________________________________________________________________________________

 

Town______________________County______________     Country_____________Post Code_____________

 

Tel. No ­­­­­­­­­­­­­­­­­­­­­­­­­­___________________Mob. No.__________________        Licence No._____________________

 

Date of Birth D/M/Y ____/_____/____ Nationality_________________ Marital Status_______________

Name of                                                  

Next of Kin________________Spouse/Partner/etc.__________          No. of Children(State Ages)_____________

 

Next of Kin Address____________________________________________________________________________

 

_______________________________Tel No.(day) ___________________(evening)________________________

 

Isle of Man Address___________________________________________________________________

­­­­­­­­­­_______________________________IOM Tel No._______________________________

 

Entries must be received by  9th June 2010

 

 

DETAILS OF RACES ENTERED

DECLARATION: (1) I/we hereby apply to enter the race(s) indicated below and declare that the motorcycle I/we enter complies in every detail with the regulations and that the particulars thereof are correct. The appropriate entry fee is enclosed

RACE 1 – Senior Race – 700cc to 1100cc   

Make

Model

cc

Year

 

 

Transponder Id No

 

 

 

 

 

 

 

 

 

 

 

 

Entrant Details  Only

Name

Licence No

Signature

 

 

RACE 2 & 7 -  600cc Race  Four strokes up to 600cc Fours, up to 675cc Triples and up to 750cc twins 

Make

Model

cc

Year

 

 

Transponder Id No

 

 

 

 

 

 

 

 

 

 

 

 

Entrant Details Only

Name

Licence No

Signature

 

 

RACE 3 & 8– 250/650cc Twins  Race -   up to 175cc to 250cc and up to 650 Fourstroke Twins

Make

Model

cc

Year

 

 

Transponder Id No

 

 

 

 

 

 

 

 

 

 

 

 

Entrant Details Only

Name

Licence No

Signature

 

 

RACE 4 -    Senior Solo Founders Race   Class 1 – 600cc Class as Race 2  - Class 2 700cc to 1100cc R

Make

Model

cc

Year

2/4

stroke

Transponder Id No

 

 

 

 

 

 

 

 

 

 

 

 

Entrant Details Only

Name

Licence No

Signature

 

 

RACE 5 & 9 – Junior Solo Founders 125/400cc Race – up to 125cc and up to 400cc four strokes

Make

Model

cc

Year

2/4

stroke

Transponder Id No

 

 

 

 

 

 

 

 

 

 

 

 

Entrant Details Only

Name

Licence No

Signature

 

RACE 6 & 11– Formula 2 Sidecar Races 

Make

Model

cc

Year

2/4

stroke

Transponder Id No

 

 

 

 

 

 

 

 

 

 

 

 

Entrant Details Only

Name

Licence No

Signature

 

 

Mutual Responsibility of Entrant and Rider:(as per the A.C.U. N.S.C.) An Entrant shall be responsible for all acts or omissions on the part of his riders, passengers, mechanics or any member of his entourage, but each of these shall be equally responsible for any infringement of the ACU National Sporting Code.

The club reserves the right to refuse any entry or forbid the use of any particular machine, which it considers inappropriate. All machines must be prepared to a high standard of cosmetic appearance.

 

 

 

 

 

 

 

 

 

 

 

 

 

Personal Accident Insurance, of the Auto-Cycle Union. For ACU/SACU Licence holders the entry fee will include Third Party Insurance and Personal Accident Insurance of the Auto Cycle Union. All other competitors must produce a copy of their start permission issued by their own federation (this includes MCUI members), which must be proof that they hold personal accident cover to the FIM minimum benefits.

RACE  - ENTRY FEES

ACU/SACU

MCUI/FMN

 

 SURCHARGE per Rider and Driver not passenger

£65-00

£30-00

**

1 – Senior Race

£30-00

£15-00

 

2 & 7 – 600cc Races

£60-00

£30-00

 

3 & 8 -   250/650 Twins Races

£60-00

£30-00

 

4  - Senior Solo Founders Race

£30-00

£15-00

 

5& 9 – 125/400cc Race

£50-00

£25-00

 

6& 11 Formula 2 Sidecar Races

£70-00

£35-00

 

Newcomers Jacket hire £7-00 refundable on return of Jacket

 

 

 Transponder hire (if required)  1 = £25,  2 = £40,  3 = £50    

 

 

2010 Club Membership (if required)                                        

 £ 7-00       

£ 7-00

 

If already a member tick box

 
TOTAL

     

** Please note the Entry Surcharge must be paid **

We have reduced the entry fee so that anyone entering two races should be paying similar to last year and if you enter more races the entry fee should be cheaper than last year.

Please make Cheque or Money Order payable to Southern 100 Motorcycle Racing Ltd Post dated cheques are not acceptable.

Closing date for Entries 9th June 2010

Entries will be received up to the last post on 9th  June 2010. This Entry Form, when complete, should be sent together with the appropriate remittances, to the Secretary of the Meeting: George Peach, Ellerslie, 128 Malew Street, Castletown, Isle of Man, IM9 1LT  Tel 01624 822546     Mobile 07624 471301   Fax 01624 823771

 Entry declaration:  I/we the undersigned apply to enter the event described above and in consideration thereof:-

·         I/we hereby declare that I have had the opportunity to read, and that I understand the National Sporting Code of the ACU, the ACU Standing Regulations, such Supplementary Regulations as have or may be issued for the event, and agree to be bound by them.

·         I/we further declare that I am physically and mentally fit to take part in the event and I am competent to do so.

·         I/we further agree and consent to any necessary information concerning an injury at this or any event being given by any attending doctor/paramedic/first responder or any hospital health care worker to the Clerk of the Course or his designated officials, and also to my own doctor and relatives. The doctor(s) may also give information to other persons according to the doctor’s own professional ethical code.

·         I/we confirm that I/we understand the nature and type of event I am 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 on page 2 which I/we compete on shall be suitable and proper for the purpose.

·         I/we confirm that I/we are eligible to compete on the machines for which I/we have entered

·         I/we confirm that if any part of the event takes place on a public highway, the machine(s) described below 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.

·         I/we confirm that 1/we are not suspended from competition in ACU permitted events

·         I/we understand and agree that I/we am required to register my arrival by signing-on at the event/race control office or other designated area at the times set out in the Final Instructions.

·         I/we accept that this entry, if accepted, will form a contract between the Club and myself, which will be governed in all respects in accordance with Isle of Man Law. I/we irrevocably submit to the jurisdiction on the Isle of Man Courts in respect of any legal action or proceedings arising out of the contract or my participation in the meeting.

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 acknowledge that even in the event that negligence on the part of the ACU, 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/we have read the above and acknowledge that my/our participation in motorsport is entirely at my/our own risk.

 

Competitor’s signature:  ………………………… Passenger’s signature: …………………………………………

Entrant’s Signature ………………………………-

 

 

 

 

ENTRIES CLOSE 9th JUNE 2010

This section must be filled in by all competitors

 

 

Vehicle Make, Model & Colour …………………………………………………………..

(to help us find you in Paddock)

Vehicle  Registration No ……………………………………………………………………

 

Registered Club Member (if any)…………………………………………………………..

 

Are you a newcomer to this circuit?………………………………………………………..

 

Are you a newcomer to the Southern 100? …………………………………………….

If not, details of any previous experience of the Billown Circuit

 

.............................................................................................................

 

..............................................................................................................

 

Details of other Road Racing experience and recent successes, over the last five years  from - 2005  to Present                               

DATE

CIRCUIT

STATUS – Club/Nat/Int.

POSITION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATA PROTECTION ACT

 

The club has a list of all the rider’s addresses on computer, which will be only used by the Club.  If you have any objection to your name being held on our computer, please let the secretary know and your name will be removed.

 

 

Please ensure that you have filled in each page and signed page 3

Thank you

N B  All non ACU/SACU Competitors need a FIM non Championship Licence