Applications are now CLOSED

Instructions

1.  Please PRINT out this form

2.  Complete, not forgetting to read and sign the attached indemnity

3.  Enclose a STAMPED SELF-ADDRESSED ENVELOPE

4.  Enclose a cheque payable to 'HVRC' :

5. Post enclosing both cheque and S.A.E. to :

Your entry includes a souvenir plaque if received by 1^st June 2010

Indemnity

I agree to be bound by the regulations that are issued for this event. In consideration of the acceptance of this entry or my being permitted to take part in the event, I agree to save harmless and keep indemnified such person, persons or body as may be authorised by the organisers to promote or organise this event and their respective officials, servants, representatives and agents from and against all actions, claims, costs, expenses and demands in respect of death or injury to myself howsoever caused arising out of or in conjunction with this entry or my taking part in this event, and notwithstanding that the same may been contributed to or occasioned by the negligence of the said bodies, their officials, servants or representatives or agents. Furthermore, in respect of any parts of this event on the ground where third party insurance is not required by law this agreement shall in addition to the parties names above extend to all and any other participant/s and their servants and agents and to all actions, claims, costs, expenses and demands in respect of loss or damage to the person and property of myself, my driver(s), passenger(s), or associated personnel. I declare that the use of the vehicle hereby entered will be covered by insurance and road tax as required by the law which is valid for such part of this event as shall take place on roads as defined by law. 

 Entrant Signature:  ______________________________________  Date: ___________

The Harpenden Village Rotary Charitable Trust Registered Charity Number 1032626