Entry Form Llanthony at Dulas 5th May 2025 -

Rider Name *

First

Last

Solo rider and sidecar driver details

Email *

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Date of Birth *

Riding Number *

AMCA or Welsh Championship Riding Number

AMCA License Number *

AMCA Classic or Modern License Number; enter 0 if no license held and day license required.

AMCA Club

Class (1st bike) *

Passenger Name (Sidecars only) *

First

Last

AMCA License Number (sidecar passenger)

AMCA Classic or Modern License Number; enter 0 if no license held and day license required.

Date of Birth (sidecar passenger) *

Machine #1 Make, Model *

Make and model of machine

Machine #1 Capacity (in cc) *

In cc numbers only

Machine #1 Year *

Year of manufacture

Class (2nd bike) *

Sidecar drivers select Sidecars for your 1st class; you can select a solo bike in 2nd class

Machine #2 Make, Model

Make and model of machine 2 (if you have one)

Machine #2 Capacity (in cc)

In cc numbers only

Machine #2 Year

Year of manufacture

Choose your entry type *

Solo - £46.00

£1.00 of the entry fee is to cover online banking charges and is non-refundable. Same cost as the first-class stamp for a postal entry

Do you need a day license ?

Day License - £15.00

Select the items you need; if you don't have an AMCA license you need to select a day licence. Licenses will be checked at the event.

Signature

Clear Signature

Declaration: Motor racing can be dangerous and may involve serious injury or death. You must read and agree to the following declaration which is designed to create a legally binding relationship in order for you to enter and compete. I confirm that the machine (s) entered by me comply with AMCA Classic Rules. 1. I confirm that the information in this entry form and the information and my acceptance of the terms of my licence are correct. 2. I confirm that I understand the nature of the competition and I am competent to take part 3. I confirm that the vehicles I use will comply with the regulations and will be safe and fit for use in competition. 4. Before taking part in the event I will ensure (unless prohibited) that I have inspected the venue, track and the facilities and geographical features and that I am satisfied that it is safe to compete 5. I will not take part if I have any doubt about my ability or the safety of the venue 6. I accept that the completion in motor sport may involve the risk of injury or death and I agree to take part at my own risk 7. Before taking part in the event I read and be bound by and comply with general regulations and my supplemental and final instructions issued by the AMCA, the organisers, the circuit owners and the regulatory body. 8. I will not participate whilst under the influence of alcohol or intoxicating drugs and that if I am taking any prescribed medication I will inform the event organisers and seek approval before taking part.

Total

£0.00

Stripe Credit Card *

Card

Name on Card