| NAME: | |
| ADDRESS: | |
| CLUB: | COMP. LICENCE NO: |
| MACHINE: | GRADE: |
| RIDING NO: | ENTRY FEE ENC: |
INDEMNIFICATION
In consideration of the acceptance of this entry I agree to save harmless and keep indemnification the Motor Cycle Union of Ireland & Ulster Centre and the promoting club, including the owners and lessees of land used for the event and their respective Officials, Servants, Representatives or Agents from and against all actions, claims, costs, expenses and demands in respect of death or injury to or loss of or damage to the person or property of myself or passenger or mechanic (as the case may be) howsoever caused arising out of or in connection with my taking part in this event, notwithstanding that the same may have been contributed to or occasioned by the said bodies, their officials, servants, representatives or agents.
Furthermore, in respect of any parts of this event on ground where Third Party Insurance is not required by Law, this Agreement shall in addition to the parties named above to extend to all and any other competitor(s) and their servants and agents and all actions, claims, costs, expenses and demands in respect of loss or damage to the person or property of myself, my driver(s), passenger(s) or mechanic(s).
SIGNED (COMPETITOR):........................................................
PARENT/GUARDIAN:...............................................................
DATE:........................................................................................
IF JUNIOR, ENTRY FORM MUST BE SIGNED BY PARENT OR GUARDIAN.
ENTRIES TO: