Please complete the following attendance and participation registration and disclaimer form with details of your driver’s licence or valid form of identification. Please send a signed and completed form to rush@xoticar.com.au.

FULL NAME: ............................................................................................................................

DATE OF BIRTH: ......................................................... Male Female

PHONE:.....................................................................................................................................

Are you participating in some track time? ...................... Yes No

If YES, please fill in these details:

Car type: ..................................................................... Man Auto

Driver’s Licence No: ............................. Exp Date: ...........................Class of Licence: ...................

How many years have you been driving? ......................................................................................

Have you experienced any track time before? ...............................................................................

Have you had any defensive driving courses? When? ....................................................................

GUESTS COMING

1. NAME ............................................................................... AGE .............................................

2. NAME ............................................................................... AGE .............................................

3. NAME ............................................................................... AGE .............................................

4. NAME ............................................................................... AGE .............................................

Important Notes

• Arrival time is 9.30am sharp to attend the safety briefing and track layout presentation. If you do not attend the safety briefing, you will NOT be allowed on the track.

• Helmets are compulsory. If you have your own helmet, please bring it along, otherwise a helmet will be supplied. *Personal helmets must have Australian standards sticker visible.

• Long cotton pants, long sleeved cotton shirt, and enclosed shoes are a requirement to race.

RUSHE N T R Y F O R M28TH SEPTEMBER 2014

RUSH E N T R Y F O R M

For the purposes of this disclaimer “XOTICAR”, “RAC” and their related entities, promoters, sponsor organisations, land owners and lessees, organisers of the event, together with their respective employees, directors, contractors, representatives and agents are not liable for any loss, damage, injury or death to person or property occurring at the event as a result of any motor or entertainment display accidents or any other events whatsoever, whether or not the loss, damage or injury is due or alleged to be due to negligence or misconduct of participants and attendees, XOTICAR, RAC, or a third party.Motorsport is dangerous and spectators attending this event do so entirely at their own risk. It is a condition of entry that all persons attending this event are absolved from all liability arising out of any accidents causing damage or personal injury or death to spectators, drivers or passengers, except where due care has not been exercised. It is accepted that under no circumstances should spectators enter the track area at any time during the event.I, being the individual described on page 1 of this Participant Registration and Disclaimer Form (“Participant”), and taking part in the event specified on page 1 acknowledge, declare and agree:

1 To obey the directions of the facilitators, trainers, organisers, or any other persons nominated by XOTICAR and RAC to instruct or otherwise control the event, and to abide by all regulations, rules and procedures communicated to me at all times;2 To (i) drive in a safe and responsible manner at all times; (ii) abide by applicable road rules; (iii) be responsible for the safety of the vehicle(s) I am driving; (iv) be responsible for the safety of any passengers in the vehicle I am driving3 Motoring activities are inherently dangerous and notwithstanding the exercise of care and skill by RAC, accidents causing death, bodily injury and property damage can and do happen;4 Whilst XOTICAR and RAC guarantees that the services it provides at the event will be provided with due care and skill and will be fit for purpose, to the extent permitted by law (pursuant to Australian Consumer Law), no other warranties or guarantees are provided to me in respect of the services, whether expressed or implied;5 To the maximum extent permitted by law, XOTICAR and RAC will not be held responsible or liable whether in negligence, contract or otherwise if any person (including myself) incurs, experiences or suffers any accident, direct or indirect loss (including but not limited to any loss suffered to property or person and economic loss), damage, fatality, injury (including psychological trauma and burns), inconvenience or health related issue whatsoever arising out of or connected to my participation at the event or course;6 That if I do not observe or follow the obligations imposed on me, I fully and finally release and discharge XOTICAR and RAC from any liability, claim, action, right, entitlement, expense or cost I may have or incur arising out of my conduct, acts or omissions at or connected to the event or course;7 By participating in the event or course my person and property may not be covered by my private contracts of insurance;8 That I have been advised by XOTICAR and RAC of the licence requirements for participating in the event and, if applicable, I hold a current and valid licence that allows me to legally participate in the event.9 That, notwithstanding the terms of clause 8 above, I will not participate in any activity in the event for which I do not hold a required licence to legally participate;10 At no time during my participation at the event will I be under the influence of any drugs, alcohol or anything else that may affect my ability to drive or passenger a motor vehicle;11 I do not have any known medical conditions and am not taking any medication that may affect my ability to drive or passenger a motor vehicle or for which I have been advised not to drive or be a passenger;12 Where applicable, my motor vehicle/s is/are registered and road worthy;13 Without prejudice to the positive obligations in clause 2 above, that I will not act, or omit to act, in any manner that is dangerous or unsafe at any time; and14 I will immediately advise the relevant driver trainer or instructor of any changes in mine or the vehicle’s circumstances if and when it occurs during this event.

Driver’s Signature .................................................... Print Name ...........................................

Date .......................................................................... Date ......................................................

Disclaimer of liability - Important NoticeWhilst activities at our centre are supervised by fully qualified staff and undertaken with due care and skill, driving activities are dangerous. There are protections you are afforded by law. Please read the below disclaimer carefully to understand your rights and responsibilities.