Entry form DMSB - Nationale Rallyes A + Rallye 200

Entry form DMSB - Nationale Rallyes A + Rallye 200
ADMV-Rallye Kurstadt Bad Schmiedeberg
c/o Remo Palm
Weinbergstr.6A
06905 Bad Schmiedeberg - Germany
Tel. / Fax: +49 (0) 34925-79484
eMail: r.palm@ebawe.de
Entry form
7th ADMV-Rallye Kurstadt Bad Schmiedeberg 2012 (Rallye 200 EU/NEAFP)
Date: 15.September 2012 Entry closing date (reduced): 03.09.2012 Entry closing date (normal) 09.09.2012 )
Class: _______________ Group: ___________
Filled by the organisator: START-NO.
Nennungseingang:
Nenngeld EUR
bar / Überweisung
Versand der Nennungsbestätigung
mit Unterlagen am:
Group: Class:
� S 2000-Rally � Group R 4 � Group R 3 � Group R 2
� Group R 1 � Group RGT � Super 1600 � Kit-car
� Group A � Group N � Group F � Group H
� Group G � GroupAT-G � Group CTC � Group CGT
� Group GT2 � Group GT3* � Appendix K
(* mit DMSB-Rallye-Datenblatt)
Turbo: � Yes / � No Mechanic Charger: � Yes � No
All wheel drive: � Yes / � No Fuel: � Benzine / � Diesel / � Gas
Entrant ____________________________ Sponsor ___________________________
Adress ________________________________ Adress ______________________________
Licence-No.: _______________________________ Licence-No.: ______________________________
Driver: Co-Driver:
Surname _______________________________ Surname ________________________________
First Name ______________________________ First Name ______________________________
Street _________________________________ Street _________________________________
Post.code/Location__________________________ Post.code/Location __________________________
Nationality _______________________________ Nationality ___________________________
Tel./Fax _________________________________ Tel./Fax _________________________________
Mobil __________________________________ Mobil _________________________________
E-Mail ___________________________________ E-Mail __________________________________
Lic.-No. ___________ Date of birth _____________ Lic.-No. __________ Date of birth _____________
□�Int.C □�Int.R □�Nat.EUP □�Nat.A □�Nat.C □�Int.C □�Int.R □�Nat.EUP □�Nat.A □�Nat.C
Car/Make _________________________ Model ____ ______________________________
Cyl.capacity _______ ccm Year of manufact. ________ Registration No._______________
Capacity: _________ KW / _________ HP Weight: ____________________ kg
FIA Homologation No.: ______________Chassis No.: ________________________________
Please tick off where applicable ���� !
It is assured that the
□ Driver
□ Entrant is the owner of the users vehicle.
□ The entrant or driver are not the owner of the used vehicle. The vehicle owner gives the following waiver in this form.
If the statement is not correct, the entrant / driver will not assert any claims to the circle mentioned in the waiver, except damages such as injuries of life, injuries of the
body or the health, caused by intentional or careless fail in duty – but also caused by a legal representative or a helper of the circle - , and except other damages
caused by intentional or careless fail in duty – also of a legal representative or a helper of the circle.
This statement of release refers to claims against other participants such as entrant, driver or co-driver, whose helper, owner and holder of other vehicles, the own
entrant, the own driver, the own co-driver as well as own helpers; caused in connection with special stage (s) to reach top speed or the shortest running-time or the
appendant practice drive (s).
The entry fee must be paid with the delivery of the entry form.
□ The entry fee __________ EUR was paid cash □ / per bank transfer on ____________ (date, copy enclosed)
Address for
correspondence
□ Driver
□ Co-Driver
(without statement Driver)
□ Participation at
optional checks and
Scrutineering
Only for organisers
notes!:
Car document: □
Rally vehicle owners
disclaimer: □
Insurance: □
Licence-Driver: □
Licence-Co-Driver: □
Driving Lic. Driver: □
Driving Lic. Co-Driver: □
Agreem. Legal representative: □
______________
Vermerke techn. Abnahme:
__________________
__________________
__________________

General contract declaration of entrant, driver and co-driver
Entrant, driver and co-driver must be make been valid facts in the person of the behaviour of a team member (entrant, driver, co-driver, mechanics,
assistants and so on), that refers the contractual relationship with the organiser or justify a claim for compensation for and against themselves.
Entrant, Driver and Co-driver are liable for all obligations from the entry contract co-debtors.
Entrant/driver/co-driver assure, that all the information in the entry form are correct and complete, that driver/co-driver absolutely be equal to the requirement of racing
competitions, the vehicle in all points corresponds to the technical definitions of the series, the vehicle in all parts can be examined by the scrutineers. The vehicle will be
only used in perfect technical and optical state during the respective event.
They declare by their signature that
- they have knowledge of the International Sporting Code by the FIA (Fédération Internationale de l’Automobile), the Anti-Doping-Regulation by the National Anti-Doping
Agency (NADA-Code), the regulations by the DMSB, the General prescriptions of the Championship, the special prescriptions of the series, the Arrangement for Right
and Procedure (RuVO),the environmental guidelines by the DMSB and the other regulations of the FIA and the DMSB
- they will acknowledge them for themselves and will follow them,
- this rules and regulations and the declaration in this entry becoming a component of the contract with the organiser,
- the DMSB, his jurisdiction, the stewards and the organiser – each in case of their responsibility – are entitled to set next to other measures also penalties is case of
breach of the athletic rules, sport-legal definitions and contractual obligations – planned as in the ISC, the RuVO, the prescriptions, the regulations, and other terms –
regardless of the right, to take the legal action according the ISG, the RuVO and the prescriptions,
- they oblige to take no drugs or foul methods like is defined in the list of Anti-Doping-Rules by the WADA and the Anti-Doping-regulations by the FIA.
Protest and appointment proxy
Entrant, driver and co-driver authorize themselves mutually with delivery of the entry to act the in each case other in the protest and appointment
procedure. They authorize themselves each other to the delivery of protests and their revocation, announcement, to appeal, to confirm, to cancel and
to renounce the appointment and to make all possible applications within the protest and appointments procedure or to accept declarations.
Entrants, drivers and co-drivers statements regarding the exclusion of liability
The participants take part in the events at their own risk. They bear the sole responsibility under civil and criminal law for any damage caused by them or the vehicle used,
if no exclusion of liability is agreed.
By submitting their entries entrant, driver und co-driver waive any claims or rights to pursue action for damages in connection with the event against
●the FIA, the DMSB, and/or ist affiliated and member organisations, the Deutsche Motor Sport Wirtschaftsdienst GmbH, their presidents, exclusive bodies, managing
directors, secretaries general
●the ADAC local and regional clubs, the promoter/series organiser,
●the organiser, the officers, road owners, government agencies, racing services and all other persons involved with the organisation of the event.
●the organisation responsible for the constructions and maintenance of roads, where damage is caused by the condition of the roads (including accessories) used during
the event an
●any agents or other persons employed to perform an obligation on behalf of the above persons an entities
except for damage or harm of life, body or health resulting from deliberate or negligent breach of duty by the group of persons release from liability,
their legal representatives or agents and except for other damage resulting from the deliberate or grossly negligent breach of duty by the group of
persons released from liability, their legal representatives or agents;
against
●the other participants (entrants, drivers, co-drivers), their assistants, the owners or registered keepers of other vehicles,
●their own entrants, drivers, co-drivers (baring any other special agreements between entrants and driver/s and/or co-driver/s!) and their own assistants
they waive claims for any kind of damage originating in connection with the special stage/s to achieve maximum speeds or shortest driving times or during
the
tests/reconnaissance, except for damage or harm to life, body or health resulting from the deliberate or negligent breach of duty by the group of persons released from
liability, their legal representatives or agents and except for any other damage resulting from the deliberate or grossly negligent breach of duty by the group of persons
released from liability, their legal representatives or agents. .
The exclusion from liability shall become effective for all parties concerned upon submission of the entry form to the organiser.
The waiver of liability applies to claims for any legal reason whatsoever including but not limited to claims for damages based on contractual and not-contractual liability
and to claims from tortuous liability . Implied exclusions from liability shall remain unaffected by the above non-liability clause.
By submitting their entry thy entrants/registered owner(s)/drivers/co-drivers acknowledge that motor vehicle insurance (motor vehicle third party liability, Casco
comprehensive/collision damage coverage and accident-insurance for the occupants does not cover any damage or claims incurred during the event. They undertake to
pass this information on to the owner of the vehicle used.
In case of a bodily harm which happened or diagnosed during the event or in case of damages of health which put the fitness to drive into question for perpetuity or
temporary the signatory absolved all attending physicians in view of possibly safety risk for third-party from patient/physician confidentiality against the responsible officials
(medical officer, clerk of the course, stewards of the meeting)
_______________________________________________________________________________________________________________________________________
Place date signature of legal representative
_______________________________________________________________________________________________________________________________________
signature driver/co-driver signature of the entrant – if not the same person –
Rally Vehicle Owner´s Disclaimer
(Only required of entrant, driver or co-driver are not owner of the rally car to be used during the event)
I agree with the participation of my car indicated on the entry form in the event and confirm my waiver of any claims or rights to pursue action for damages in connection
with the participation in the event against:
●the FIA, the DMSB and/or its affiliated and member organisations, the Deutsche Motor Sport Wirtschaftsdienst GmbH, their presidents, executive bodies, managing
directors, secretaries general,
●the ADAC local and regional clubs , the promoter/series organiser,
●the organiser, the officers, road owners, government agencies, racing services and all other persons involved with the organisation of the event
●the organisation responsible for the construction and maintenance of roads, where damage is caused by the condition of the roads (including accessories) used during
the event, und
●any agents or other persons employed to perform an obligation on behalf of the above persons and entities
except for damage or harm to life, body or health resulting from the deliberate or negligent breach of duty by the group of persons released from liability, their legal
representatives or agents and except for any other damage resulting from the deliberate or grossly breach of duty by the group of persons release from liability, their legal
representatives or agents
against
●the entrants, drivers, co-drivers, registered keepers or owners of other used vehicles, the assistants of the participant/s which is/are specified in the entry form and the
other participants and against the entrant/s, driver/s, co-drivers of the vehicle provided by myself (barring any other special agreements between owner of the vehicle,
entrant/s, driver/s, co-driver/s!)
I confirm my waiver of claims for any kind of damage origination in connection with the special stage/s to achieve maximum speeds or shortest
driving times or in connection with the tests/reconnaissance, except for damage or harm to life, body or health resulting from the deliberate or
negligent breach of duty by the group of persons release from liability, their legal representatives or agents and except for any other damage
resulting from the deliberate or grossly negligent breach of duty by the group of persons released from liability, their legal representatives or agents.
The waiver of liability applies to claims for any legal reason whatsoever, including bit not limited to claims for damages based on contractual and non-contractual liability
and to claims from tortuous liability. Implied exclusions from liability shall remain unaffected by above non-liability clause.
_____________________________________________________________________________________________________________________________________
Place, date signature name and address of vehicle owner in block capitals