UGP 2019 Rider Entry Form

DUNDROD & DISTRICT MOTORCYCLE CLUB LTD.
ULSTER GRAND PRIX BIKE WEEK

7th - 10th August 2019
ENTRY FORM

MCUI (Ulster Centre) Permit No. 046/19 & FIM Europe Permit No. EMN 10/640
THIS RACE WILL BE HELD UNDER THE INTERNATIONAL COMPETITION RULES OF THE FIM AND THE MOTORCYCLE UNION OF IRELAND. THESE REGULATIONS AND ANY FURTHER REGULATIONS SUBSEQUENTLY ISSUED.
Entrant (if not rider)
Name *

First Name Last Name
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Date Of Birth

Month Day Year
Date
License Number
Governing body whom issued
Rider
Name

First Name Last Name
Email
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
License Number
Governing body whom issued
Blood Group
Machinery Information
Riders Road Racing Experience
No. Of Years
Details of Road Race Circuits ridden
Dundrod Circuit Newcomer? (tick box if yes)
*ENTRIES CLOSE ON FRIDAY 28th JUNE 2019*
ENTRY FEES: All Classes £50 (€65) per each race
or maximum total of £200 (€240) per rider for meeting.
All cheques payable to Dundrod MCC.

CLOSING DATE FOR ENTRIES: Friday 28th June 2019

RACE SECRETARY: Mrs L. Coulter, 10 Belfast Road, Nutts Corner, Crumlin BT29 4TQ, Northern Ireland Tel: 028 9082 5498 Email: lindac4@btinternet.com
Please Note: No entry will be accepted unless made on the proper entry form, properly completed and accompanied by the correct entry fee. No Late Entries Accepted.

MOTORSPORTS CAN BE DANGEROUS AND MAY INVOLVE INJURY OR DEATH
You must read and agree to the following declaration and paragraphs below which are designed to create a legally binding relationship in return for your being allowed to enter and compete.

I confirm that the information in this entry form and the information and my acceptance of the terms of my competition licence are correct. I confirm that I understand the nature of the competition I am entering and I am competent to take part.

I confirm that any vehicle that I use will comply with the regulations and will be safe and fit for use in the competition.
I will satisfy myself (by sighting lap or otherwise) before taking part that the venue and track is acceptable to me with regard to its features and physical layout (unless prohibited to do so).

I will NOT take part if I have any doubt about my ability or the safety of the venue.

I accept that competition in motorcycle sport may involve injury or death and I agree to take part at my own risk.

Before taking part in the event I will read and be bound by and comply with any regulations and final instructions issued by the organiser, circuit owners and the governing bodies.

I will not participate whilst under the influence of alcohol or intoxicating drugs and that if I am taking any prescribed medication I will inform the event promoter and seek approval to participate before taking part.

If under the age of 18, my parent/guardian has read the above and signed the declaration and agreement below.
Digital Signature
Date

Month Day Year
Date
PERSONAL INFORMATION - PLEASE COMPLETE ALL SECTIONS
Name

First Name Last Name
Phone Number

Area Code Phone Number
Date

Month Day Year
Date
Age
Occupation
Select one of the following categories which may apply to you in relation to your participation in this event.
Employee - someone working under a contract of employment i.e. subject to the authority and instruction of the employer. Non-employed - a person engaging in sport as a past-time/for pleasure rather than for financial benefit or professional reasons. Self-employed - person who works for gain or reward otherwise than under a contract of employment, whether or not he/she him/her-self employs other.
COMPETITOR EMERGENCY CONTACT DETAILS – Next of Kin & Team Contact
Competitor
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Name of your Next of Kin Details
Next of Kin Name

First Name Last Name
Address of your next of Kin

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Relationship to you
Team Member Contact Details at Event
Name of Team contact

First Name Last Name
Phone Number

Area Code Phone Number
2019 Regulations can be downloaded by clicking HERE
Please click submit below to send your entry.
Should be Empty:

DUNDROD & DISTRICT MOTORCYCLE CLUB LTD.

ULSTER GRAND PRIX BIKE WEEK

ENTRY FORM

Machinery Information

Riders Road Racing Experience

*ENTRIES CLOSE ON FRIDAY 28th JUNE 2019*

PERSONAL INFORMATION - PLEASE COMPLETE ALL SECTIONS

COMPETITOR EMERGENCY CONTACT DETAILS – Next of Kin & Team Contact

ENTRIES CLOSE ON FRIDAY 28th JUNE 2019