LUTONG DRAG RACE 2016 (7th – 8th May 2016) (Permit:FTMT no. 39/2016 Dlm 61/17)

REGISTRATION FORM Important Notice to All Participants         

Closing date for registration is 30th April 2016. Any late registration will have additional RM50.00 penalty. The Organizer will not be responsible for any theft, accident or death before, during or after the race progresses. The Organizer reserves the right to disqualify any racers found that does not comply with any conditions or engaged in any form of activity that violates decency and discipline. The Organizer reserves the right to make changes to the schedule of races and prize money if the car category does not meet the minimum requirements. The organizer reserves the right to cancel or change the date of the race The organizer reserves the right to reduce or combine car categories. The organizer reserves the right to issue additional conditions. Please fill in indemnity form upon “checking-in” on Race day. Please refer to the Racing Format specifications & Terms and Conditions for race for more information.

RACER’S DETAILS Full Name :

IC No. :

Contact No. :

Country/State:

Team Name (if any):

Vehicle Model :

RACE CATEGORIES (Please mark "√" in the circle box for your choice of racing categories) ⃝ Class A - NA <1.6cc (Street)

⃝ Class F - NA <1.8cc (Pro)

⃝ Class B - <1300cc Turbo NA (Pro)

⃝ Class G - VTEC (Pro)

⃝ Class C - Save the SOHC <1.6cc (Pro)

⃝ Class H - Diesel (Pro)

⃝ Class D - VTEC (Street)

⃝ Class I - Turbo only 2WD (Pro)

⃝ Class E -VTEC 4-Door (Street )

⃝ Class J King of Drag (Pro)

CONFIRMATION OF RACERS I hereby acknowledge that I have read and AGREE with all the conditions of the Specifications & Race format that has been set. Any risk of motorsports participation is on my own responsibility, without involving the organizers of the event of any accident, death or theft before, during and after the event. I would also adhere to all instructions made by the Marshal / staff during this event. Herewith I enclose cash as payment fees totaling _____________________ for the race categories that I have selected above. Racer,

(Name / Signature)

(Date / Time)

TO BE USED BY THE SECRETARIAT FOR RACE REGISTRATION Receiver:

(Name / Signature) (Permit:FTMT no. 39/2016 Dlm 61/17)

Racer’s Number:

(Date / Time) Copyright2016©LutongDrag