Drift Registration (Driver) Please complete all sections of this form Date of Event ABOUT YOU Name * First Last * Last Address * Address Address Address Town/City Town/City County County Postcode Postcode Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Email * Telephone * Emergency Telephone * Emergency Contact Name * Emergency Contact Relationship * Emergency Contact Address * Driving Licence No (Section 5 on licence) * Any Relevant Medical History? Medical Allergies? MSA/IOPD Competition Licence Number (If known) ENTRY DECLARATION (Please Read) IOPD Authorisation No: 200039 Entry declaration: I the undersigned apply to enter the event described above and in consideration thereof:- I hereby declare that I have had the opportunity to read, and that I understand the Perranporth Driving Centre Standing Regulations, such Supplementary. Regulations as have or may be issued for the event, and agree to be bound by them. I further declare that I am physically and mentally fit to take part in the event and I am competent to do so. I confirm that I 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 accept that insurance arranged on my behalf by the organisers of the event(s) 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/our voluntary decision to engage in a high risk activity. I consent to details of any injuries I may suffer at this/these events being passed between all medical services and the Clerk of the Course. I consent to the collection and retention of my personal information by the IOPD and Perranporth Driving Centre. I confirm that the machine(s) as described below which I compete on shall be suitable and proper for the purpose. I confirm that I am eligible to compete on the machines for which I have entered. I 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 accept responsibility for any items borrowed from the Organiser during the course of the event(s). These items include but are not restricted to (safety clothing, transponders, accessories) I understand that I am liable for the cost of replacement of any items lost or not returned and non- payment or non-replacement of items borrowed may affect my entry into subsequent events. I confirm that the machine(s) as described below which I compete on shall be suitable and proper for the purpose. I confirm that I am eligible to compete on the machines for which I have entered. I 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 confirm that I am not suspended from competition in IOPD permitted events. Drifting - Please note: Sign-on for drivers and passengers opens at 8:45am and closes at 10:45am Drivers briefing is at 10:50am Failure to attend briefing will result in refusal of entry to the circuit All cars must undergo a basic safety inspection before entry is granted to the circuit A full set of panels and working tail lights must be fitted at the start of the event In-car fire extinguishers are not mandatory, however they are HIGHLY recommended Acknowledgement of the risks of motorsport: I understand that by taking part in this event I 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 IOPD, 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 / our voluntary decision to take part in a high risk activity. I have read the above and acknowledge that my / our participation in motorsport is entirely at my / our own risk. I agree that I am required to register on arrival by ‘signing on’ at the designated place before taking part in any Practice Session or Race. By ticking this box, you acknowledge that you have read and agree to the terms above * I Agree PAYMENT DETAILS Ticket Cost (£) Note: All passengers must purchase a separate ticket and complete the passenger registration form here How Would You Like to Pay? * PayPal Credit/Debit Card Credit/Debit Card Details Δ
Please complete all sections of this form
IOPD Authorisation No: 200039
I understand that by taking part in this event I 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 IOPD, 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 / our voluntary decision to take part in a high risk activity. I have read the above and acknowledge that my / our participation in motorsport is entirely at my / our own risk. I agree that I am required to register on arrival by ‘signing on’ at the designated place before taking part in any Practice Session or Race.
Δ
