Taipatrack

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Taipa Stock and Saloon Car Club
Organiser: John Hockenhull, Marty Lorenz
Address: Oruru Road Taipa
Phone: 02102294417

I wish to enter the Demo Derby on the _____________ (date), and agree to abide by the Rules. I also hereby absolve the Taipa Stock and Saloon Car Club and its members from any claim arising from injury or damage sustained or caused by me whilst at their racetrack.

Driver’s full name: ___________________________________

Driver’s signature: ____________________ Date: __________

Address: ___________________________________________

Phone Number: _____________________________________

Type of Car: ________________________________________

***********************************
If applicable

Passenger’s full name: ________________________________

Passenger’s signature: ________________________________

Passenger’s address: __________________________________

Piczo