Throttle Thrust III

Affix Recent
Photograph
(3.5 cm x 4
cm)
ENTRY FORM

PARTICIPANT DETAILS

Full Name
Fathers Name Date of Birth
Address

Town/ City State

Mobile Tel (Off.)
Email Allergy Blood Group
Drivers Licence Place of issue Validity

INSURANCE DETAILS
Policy No Issued by Validity

VEHICLE DETAILS
Make Model
Registration No. Engine No
Chassis No. Cubic Capacity Year of Manuf.

CATEGORY (Tick the appropriate box)

Below 1300 Above 1300 SUV

IMPORTANT NOTICE
As the track and the surrounding area is the premises of private party, it is requested that all competitors to protect the environment
and avoid accidental spillage of oil on the permises and also take proper care in discarding any debris or waste / food, please be
responsible in using the waste bins provided in the permises. Participants are requested to avoid any intoxicating substancesof any
form during the running of the event and also not to behave in any unsporting manner that may jeopardize the running of the event.
Participants should observe every road rules outside the competitive track and in public areas. infringements will lead to RTO/Traffic
Police regulations and further fines / refusal to start event. The organisers will not take any responsibility for RTO / Traffic Police fines
or other action for any illegal or safety violations

Declaration: I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake
to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or
misrepresenting, I am aware that I may be held liable for it.

Date __________________ Signature of the participant _____________________________

FOR OFFICE USE ONLY

Date received Date Paid Amount
Remarks Receipt No.