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Entry Form .pdf


Original filename: Entry Form.pdf
Title: Entry Form
Author: sputera

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ENTRY FORM

Sanctioned by:

Please complete entry form in capital letters

Date :

Round :

Venue : MAEPS, SERDANG

Competition No.

RIDER INFORMATION
Name
IC/Passport No.

Competition License No.

Address
Postcode

Country

Telephone

Mobile

Email
Date of birth

Nationality

Next of kin (2 contact person)
Name

Phone

Name

Phone

TEAM INFORMATION

*Please submit a valid AAM or MAM Team License (or any FIM affiliates)

Team Name
Entrant License no.
Address
Telephone

Fax

Email
Team Manager’s Name
Team Manager’s Email

Team Manager’s contact no.

MOTORCYCLE INFORMATION (Only 4 stroke motorcycles)
Make

Year

Model

CC

ENTRY FEES

EARLY BIRD

NORMAL

FIM Asia Supermoto Open - Unlimited Supermoto up to 450cc

250

300

SM Open - Unlimited Supermoto up to 700cc

200

250

SM Novice - Unlimited Supermoto up to 700cc

180

200

SM Veteran - Unlimited Supermoto up to 700cc - (45 years & above)

150

180

SM CKD Open - Production Supermoto Unlimited up to 200cc

100

150

SM CKD - CKD Supermoto Unlimited up to 200cc

100

150

*Registration and payment 1 week before event date will be consider “EARLY BIRD”.

LIABILITY INDEMNITY

By submitting this entry form, the participant (rider and team) waives all rights and titles to any legal claim arising from any accident or damage caused in
conjunction with his participation in the meeting against:
• Asia Supersports Group Sdn Bhd, their directors, members, employees and officials;
• Member-clubs and their Co-organisers; Organiser/promoter, his/their representatives, stewards and assistants;
• The owner(s) of the property used for the meeting (including structures and installation of the circuit), used for the meeting, his (their) representatives and
assistants;
• The other participants and their attendants as well as against his/their own assistants in so far as a race or special tests for attaining high speeds or best
times are concerned;
• Authorities, race services and any other organisations or corporate or natural bodies involved in the organisation of the meeting.
The participant accepts the above conditions and commits himself to comply strictly with them. Moreover, the participant accepts that if his health is affected in
such a manner that his fitness for continuing in the meeting has been put in question, regarding the safety risk also affecting third parties, he releases all the
doctors in attendance from their obligation to professional secrecy towards the officials carrying responsibility of the meeting (Chief Medical Officer, Clerk of the
Course, Sporting Stewards respectively).
By submitting this entry form, the participant (rider and team) declares and recognises that he takes part in the meeting(s) referred to in this entry form at his
own risk. He bears the sole liability regarding applicable civil and penal laws and regulations for any and all damages caused by him or by his motorcycle arising
from his participation in the meeting(s). If the rider himself is not the owner of the motorcycle used by him during the meeting, he releases all those persons
listed in the preceding paragraph (Liability waiver) from all the claims which could be filed by the owner of the motorcycle or submits, together with the entry
form, the relevant waiver from the owner of the motorcycle.

COPY RIGHTS

By submitting this entry, the participant (rider and team) herein formally acknowledges and accepts that Asia Supersports Group Sdn Bhd, promoter of the
Malaysian Supermoto Championship 2015 has full and exclusive right to utilise the filmed and/or photographic and/or video recorded and/or computer created
images portraying the participants and/or teams, rider(s) name(s), motorcycle(s) and wardrobe fittings (including number and helmets), sounds, voices and any
sign, logo trademark of any nature or type in connection with the public exhibition, distribution, television broadcasting and in general exploitation of the Asia
Supersports Group Sdn Bhd Malaysian Supermoto Championship 2015 meetings or any of them in any of its classes, applying them onto products including
but not limited to videocassettes, videodisks, CD-Rom, Internet and interactive games, simulation games also electronically reproduced, apparel and stationary.
The participant (rider and team) waives hereunto any right, title and interest to file claims, objections or requests of any kind against Asia Supersports Group
Sdn Bhd (including but not limited to its assignees, licensees and successors) related with the use and/or the exploitation of any of the above rights in all forms,
in the entire world and without time limits.

PRIZE-GIVING CEREMONY

All podium prize winners must be present at the official prize presentation after each race, failing which all trophies and cash awards shall be forfeited. Winners
must also dress in proper attire.

Organizer’s Approval:

Rider’s Signature:

Team Manager’s Signature:

Date:

Name:

Name:

The above declaration must be signed by parent(s)/legal guardian if the competitor is under the age of 18 as at the date of this entry.

Name of Parent/Legal Guardian:

Signature of Parent/Legal Guardian:

NRIC/Passport No.:

Relationship:

Tel No.:

E-mail:

International competitors are reminded that permission must be sought from their respective ASNs to participate in this meeting either in writing or by having
thisEntry Form stamped in the allocated box.

ASN’S STAMP

Entry form must be submitted to Asia Supersports Sdn Bhd before closing date which is 1 week before each race event date.
The closing time for registration is 1 hour before scrutineering.
For additional information please contact William at william@asg.my, telephone number 012 668 0470.
Promoted by:

Supported by:

MSMC

MALAYSIAN SUPERMOTO CHAMPIONSHIP


Entry Form.pdf - page 1/2
Entry Form.pdf - page 2/2

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