Competition License Application Form (Page 2 of 3) in pdf

Jamaica Millennium Motoring Club

P a g e

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2015 C

OMPETITION

ICENSE

PPLICATION

Section 1: Personal Information

Name: ………………………………………………………………………………………………………………………………………

Address: ………………………………………………………………………………………………….……………………………….

…….………………………………………………………………………………………………………………………………..………….

Telephone: (m) …………………………… (w) …………………………………… (h) …………………………………....

Email: …………..………………………………………………………………………………………………………………………….

Blood type: ………………………

Male

Female

Date of birth: (dd/mm/yyyy) ………/……../………..

Nationality: …………………………….

Name of Affiliated club of which you are a member: ______________________________

I last held a JMMC competition license in: ____________________________ (state year)

Section 2: Declaration

1. I agree that a competition license issued by the Jamaica Millennium Motoring Club is a

privilege and not a right.

2. I have read, understood and will comply with the “Documentation Required with

License Application”, and further understand that any false information given by me in

this application may lead to disciplinary action and the possible permanent withdrawal

of my license.

3. I agree that I will be bound by the International Sporting Code of the Fédération

Internationale de l’Automobile and the applicable regulations of Jamaica Millennium

Motoring Club and that I will do nothing to bring motor sport into disrepute nor commit

any act prejudicial to the interest of motor sport generally and understand that, should

I do so, disciplinary action may be taken against me.

4. I undertake not to use any drug considered illegal, or to consume alcohol prior to, or

during practice or competition.

Applicant’s Signature:

Date:

Approved by ASN:

Date:

If the applicant is under the legal age of consent in the Jamaica a Parent/Guardian must

also sign below, stating relationship

Parent/Guardian Name:

Relationship:

Date:

Signature:

Competition License Application Form Page 2