Payment Details (Please make cheques payable to the Otago Motor Club Trust)
Entry Fee
$60.00 Office Use
Lunch Tickets (No required)
@ $12.50 ea $
Car No
Buffet Dinner (No attending)
@ $30.00 ea $
Ticket No
Buffet Dinner (Children under 12) @ $12.00 ea
$ Receipt No
Total $
(1) Indemnity
We hereby acknowledge that we enter and compete in the above event
at our own risk in all respects and in consideration of this entry being
accepted we hereby undertake and agree to indemnify the New Zealand Automobile
Association Inc, its Councils and its officials and employees absolutely
from and against any claim whatsoever that may be made upon it or them
in respect of any accident, damage or injury in which our passengers, we
or the vehicle which we are driving may be in any way directly or indirectly
concerned and which may occur to any person or property whatsoever during
the course or in any way arising out of the above event (including any
postponement thereof) and whether or not owing to the fault or neglect
of any other competitor or official or employee of the Association or its
committee or otherwise whosoever.
(2) Obligations
We agree to abide by the conditions and warrant that the foregoing
particular sare true and correct in every respect We also warrant that
our vehicle is registered under the Transport Act 1962, has a current vehicle
inspection certificate and is covered by a comprehensive insurance policy.
We the driver/s hereby warrant that we are the holders of a current drivers
licence, and that we are over the age of 20 years. We acknowledge that
the decision of the sports committee is final and binding.
(3) Consent
I consent to the details contained on this form being held by Automobile
Association for the purpose of the promotion and benefit of the Sundstrum
Rally . I acknowledge my right to access and correction of this infomiation.
This consent is given in accordance with the Privacy Act 1993.
Signature of Driver ____________________________ Date ______________
Signature of Navigator _________________________ Date _______________