OFFICIAL REGISTRATION FORM Ver. 020215

Round 1 – 02/05/15
Round 2 – 05/07/15
Round 3 – 31/10/15
Round 4 – 21/11/15
OFFICIAL REGISTRATION FORM
Ver. 020215
Instructions
Please write clearly and legibly within the spaces provided. The following documents must be attached together with this form:
1.
2.
3.
Copy of Nric/Passport front and back
Copy of license
Payment amount as calculated on the 2nd page
A digital copy of a half body photograph of the driver in racing gear without helmet must be submitted via email to contact@x30challengesingapore.com . Please
reference the Driver name and Nric / Passport Number in the subject of the email.
Applications can be mailed to or submitted in person at:
AutoInc EuroSports
1 Commonwealth Lane
#01-05 One Commonwealth Building
Singapore 149544
Successful participants will be notified via email after registration closes. Confirmation of participation is on a first come, first served basis. The Organiser
reserves the right to reject any application at its discretion. No refunds will be given for cancellation of entries.
Driver / Team / Kart Particulars
Driver Name
Mailing Address
Nric / Passport Number
Age This Year
Email
Occupation
Gender
Contact Number (Mobile)
Contact Number (Home)
Team Name (If Any)
Kart Chassis Make and Model
Chassis Serial Number
Racing Class (Age Calculation by 2015 Calendar Year)
Distinction between Classes A and B (Class A for seasoned drivers, Class B for less experienced
drivers) are dependent on the individual applicant’s race experience and results for the past 2
years. Applicants may indicate their preference but the Organiser will have sole discretion over
all categories and classifications.
Cadet (8 – 13 years)
Junior (12 – 16 years)
Class Preference (Circle)
Senior (15 and above)
A/B
Class Preference (Circle
Master (30 and above)
A/B
Veteran (45 and above)
Tell Us About Yourself (Necessary for feature on the official X30 Challenge Singapore website at www.x30challengesingapore.com)
Marital Status
Number of Children (if any)
Started Karting at Age
Fastest Lap Time at KF1
Other Vehicles Owned
Other Races You Participated In
Other Karting Awards Obtained
Favourite Driver
Favourite Food
Other Hobbies
How did you get into karting?
Something not many people know about you is…
Sponsors
Single / Married
What has been your best karting experience so far?
What has been your worst karting experience so far?
Describe your racing philosophy:
Organiser: AutoInc EuroSports
Promotor: AutoInc EuroSports
Sponsor: Optima Werkz
contact@x30challenge.com
Round 1 – 02/05/15
Round 2 – 05/07/15
Round 3 – 31/10/15
Round 4 – 21/11/15
Race Participation - Cadets (Please Tick Accordingly)
Cadet
Late Entry Fee
Round 1 (02/05/15)
$100.00
$100.00 (Entry received after 18/04/15)
Round 2 (05/07/15)
$100.00
$100.00 (Entry received after 21/06/15)
Round 3 (31/10/15)
$100.00
$100.00 (Entry received after 17/10/15)
Round 4 (21/11/15)
$100.00
$100.00 (Entry received after 07/11/15)
Total
Grand Total:
Race Participation – Junior and Up (Please Tick Accordingly)
Junior and Up
Late Entry Fee
4 Rounds Package Rate
$2,400.00
Round 1 (02/05/15)
$650.00
$250.00 (Entry received after 18/04/15)
Round 2 (05/07/15)
$650.00
$250.00 (Entry received after 21/06/15)
Round 3 (31/10/15)
$650.00
$250.00 (Entry received after 17/10/15)
Round 4 (21/11/15)
$650.00
$250.00 (Entry received after 07/11/15)
Total
Entry must be received no later than 18/04/15
Grand Total:
Payment
Mode of Payment
Cheque Number (If Paying by Cheque)
Entry fee is inclusive of engine usage. Payment must be submitted via cash (in-person submission only) or cheque together with this application. Cheques should
be made payable to “AutoInc EuroSports Pte Ltd”. Kindly indicate the name and nric / passport number of the driver on the back of the cheque.
Indemnity and Declaration
I have read the regulations issued for the Meeting and agree to be bound by them. I declare that all of the information provided in this application is accurate and true. I agree to abide by the registration conditions, rules and
regulations of the X30 Challenge Singapore. In consideration of the acceptance of this entry to take part in the Meeting, subject to the restrictions or exclusions of liability ensuing from the applicable laws, I agree to save harmless and
keep indemnified AUTOINC EUROSPORTS PTE LTD, SINGAPORE MOTOR SPORTS ASSOCIATION (SMSA), ALL SPONSORS AND THEIR RESPECTIVE OFFICIALS, SERVANTS, REPRESENTATIVES OR AGENTS OR ANY FIRM, GOVERNMENT
AGENCIES OR INDIVIDUAL connected with the organisation of the event from and against all actions, claims, costs, expenses and demands in respect of death, injury and loss and damage to the person or property of myself, my driver
(s) or pit crew (s) (as the case maybe) howsoever caused arising, out of or in connection with this entry or may taking part in the meeting not withstanding that same may have been contributed to or occasioned by the negligence of
the said bodies, their officials, servants and agents. In consideration of my being permitted to participate in this meeting, I hereby undertake not to make demands or claims of any kind whatsoever against any other contestant in this
Meeting, or against any official engaged in the organisation or running of the said races arising out of any damage, injury or death that may occur during practice, racing or anytime during the course of the meeting, howsoever caused. I
understand that should I at any time during the event suffer from any disability whether permanent, temporary or otherwise that which is likely to affect prejudicially my normal control of my kart, I may not take part unless I have
declared such disability to the Clerk of the Course who will then consider whether I may be permitted to drive or not, and give his decision in writing. I agree to take full responsibility and bear all repair and replacement costs for any
damages I am judged by the Organiser to have caused to the engine and any parts provided for my use and to the facilities and property of the Organiser, SMSA, KF1 Karting Circuit, Arina International Holding Pte Ltd, all sponsors and
their respective officials, servants, representatives or agents or any firm, government agencies or individual connected with the organisation of the event.
Entrant’s Declaration - I declare that to the best of my belief the driver I have entered possesses that standard of competence for an event (s) of the type (s) to which this entry relates and kart (s) entered is / are suitable and road
worthy for the event having regard to the course and speed which will be reached.
Indemnity by Parent / Legal Guardian - If the driver is below the age of 18 at the time of submission, a parent or legal guardian must sign this indemnity. In consideration of the acceptance of this entry to take part in the Meeting,
subject to the restrictions or exclusions of liability ensuing from the applicable law, I agree to save harmless and keep indemnified AUTOINC EUROSPORTS, SINGAPORE MOTOR SPORTS ASSOCIATION (SMSA), ALL SPONSORS AND THEIR
RESPECTIVE OFFICIALS, SERVANTS, REPRESENTATIVES OR AGENTS OR ANY FIRM, GOVERNMENT AGENCIES OR INDIVIDUAL connected with the organisation of the event from and against all actions, claims, costs, expenses and demand
in the respect of death, injury, loss and damage to the person or property of myself, my deriver (s) or pit crew (s) (as the case maybe) howsoever caused arising out or in connection with this entry or may taking part in the meeting not
withstanding that same may have been contributed to or occasioned by the negligence of the said bodies, their officials, servants and agents.
Driver’s Signature and Date
Parent / Guardian’s Signature and Date (If Driver is less
than 18 years of age)
Driver’s Name:
IC / Passport Number:
Name of Entrant & Date (Racing Team Usage)
Name of Parent/Guardian:
Organiser: AutoInc EuroSports
Promotor: AutoInc EuroSports
Sponsor: Optima Werkz
contact@x30challenge.com