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V.S.B.C Online Entry Form
Entry Fee per Boat:
Senior $150
Name Of Event
*
I.e Club Day, Eppalock Gold Cup, Kilos
Boat Name
*
Class Entered
*
Please select
Unlimited Outboard
GP Hydroplane
Unlimited Displacement
Hydro / KT
F2 / SST120
6 Ltr Displacement
6 Ltr Hydroplane
Superstock 105mph
2700 Super Sports OB
Sports Mono / Mod VP
2100 Super Stock OB
1800 Super Sport OB
1.6 Litre OzLites
Formula GP
F3 / 1250cc
F4
25hp / Yamato / 550cc Outboard
Formula Future
Please select your appropriate class
Target
*
100Mph Badge
200Kph Badge
State Record
Australian Record
Australasian Record
Hull Type
*
Inboard Displacement
Outboard Tunnel
Outboard Mono
Hydro / KT
Formula Future
Inboard Only.
Unlimited
Injected
Carby
Restricted
Is your Engine Sealed?
*
Yes
No
If Yes, Seal Number
Does your boat have a cell
*
Yes
No
Boat Registration No
*
Boat Registration Expiry
*
DD
/
MM
/
YYYY
Motor Make & Model
*
Capacity of Motor
*
Hull Width in Metres
*
Hull Length in Metres
*
APBA Race Number
*
APBA Log Book Number
APBA Tech Inspection Number
*
Owners APBA Licence No
*
Owners APBA Club
*
Owners Name
*
First
Last
Owners Phone No
*
Owners Address (Optional)
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Owners or Drivers Email
*
Emergency Contact name
First
Last
Emergency Contact Phone No
Drivers Section
Drivers Name
*
First
Last
Drivers Phone No
*
Drivers Address (Optional)
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Drivers Email (Optional)
Drivers APBA Club
*
Drivers APBA Licence No
*
Drivers SBA Licence No
*
Drivers SBA Licence No
*
Drivers SBA Licence Expiry Date
*
DD
/
MM
/
YYYY
License Status
*
Full
Probation
Emergency Contact name
*
First
Last
Emergency Contact Phone No
*
Second Drivers Section
If applicable!
Second Drivers Name
First
Last
Second Drivers Address (Optional)
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Second Drivers Phone No
Second Drivers Email
Second Drivers APBA Licence No
Second Drivers APBA Club
Second SBA Licence No
Second Drivers SBA Licence Expiry Date
DD
/
MM
/
YYYY
Second Driver License Status
*
Full
Probation
Declaration by Owners:
To the Honorary Secretaries of VSBC, I / We
*
Please insert owners name in the box above.
being the owner(s) of the abovementioned boat do hereby certify that the specifications of the boats' hull and motor are known to me/us to be in conformity with the Rules and restrictions governing the class of the event entered. I/We will comply with the APBA RACING and SAFETY RULES in their entirety. I/We declare that the above particulars are to my/our knowledge true and correct.
*
Clear
Owners Please sign in the box above
Date Owner Signed
*
DD
/
MM
/
YYYY
Drivers Signature
Drivers Signature.
NOTE I the undersigned realise that powerboat racing is dangerous. I do not rely on officials or this scrutineering for the safety of the boat or my equipment and realise this is my responsibility and that safety or other equipment required cannot guarantee me or my boats safety. If I have taken the decision to use a boat fitted with a Reinforced Cockpit or a Deflection Bar or a Belt Restraint or a combination of either or all three I personally have examined these items fitted to the boat and use them totally at my own risk and at my own choice and I realise that these may make the boat more dangerous in certain conditions. I on behalf of myself, and my heirs or any other person, release all persons and organisations connected with the running, supervision, or administration of the event from any responsibility whatsoever however caused. I sign this indemnity without duress and in the full knowledge that I may be giving up certain legal rights.
*
Clear
Driver please sign in the box above
Date Driver Signed
DD
/
MM
/
YYYY
Second Drivers Please Sign below if applicable.
Second Drivers Signature.
NOTE I the undersigned realise that powerboat racing is dangerous. I do not rely on officials or this scrutineering for the safety of the boat or my equipment and realise this is my responsibility and that safety or other equipment required cannot guarantee me or my boats safety. If I have taken the decision to use a boat fitted with a Reinforced Cockpit or a Deflection Bar or a Belt Restraint or a combination of either or all three I personally have examined these items fitted to the boat and use them totally at my own risk and at my own choice and I realise that these may make the boat more dangerous in certain conditions. I on behalf of myself, and my heirs or any other person, release all persons and organisations connected with the running, supervision, or administration of the event from any responsibility whatsoever however caused. I sign this indemnity without duress and in the full knowledge that I may be giving up certain legal rights.
Clear
Second Driver please sign in the box above.
Date Second Driver Signed
DD
/
MM
/
YYYY
Amount to be paid
*
Senior $150