Autumn Run Entry Form

Autumn Run Entry Form

Sunday 18th September 2016

Name of driver/rider. ____________________________________________________

Address _______________________________________________________________

_______________________________________________________________

_______________________________________________________________

Name of owner/entrant ___________________________________________________

Make and model of vehicle_________________________________________________

Number of adults ______________ Fee enclosed € _______________

Declaration of Insurance

I declare that during the period of this event my car/motorcycle and my driver/rider thereof will be covered by a valid insurance as required by The Road Traffic Act and that such insurance shall include Rally cover and I undertake to produce same on demand to an authorized official if required.

Signed _______________________________________________________

Important Notice

Neither the submission of any vehicle for participation in any event organized by the Blessington Vintage Car & Motorcycle Club (herein called the Club) nor its consequent acceptance for the participation in any event under the direction or control of the Club or its duly appointed officials as to the mechanical condition of the said vehicle or its suitability to participate in any event, nor shall any liability attach to the Club or the said officials howsoever arising in connection with same and the signing by the entrant of any application form shall be deemed to be acknowledgement of acceptance of this condition.

Cheques etc. payable to. : Blessington Vintage Car & Motorcycle Club Ltd..