The above answers are truthful and correct.

I have not been prevented on medical grounds, from taking part in any other sport.
I do not take any prohibited substances and/or methods as per the WADA list and I do not misuse alcohol or drugs.

In case of injury/illness I give permission for the Chief Medical Officer or her Deputy, to release any relevant information to the Clerk of the Course, my relatives, my representatives, the Rider’s Welfare Officer and to any other doctors involved in my care.

I confirm that since my previous application, there have been no changes in my health including mental health, wellbeing, illness or injury.

I will immediately inform the ACU and/or the CMO/DCMO of Southern 100 MCC in the event of any changes in my health including mental health, wellbeing, illness or injury.

I agree to the details of my medical history being sent to the CMO/DCMO of Manx Roadracing Medical Services as part of my licence application.

In case of emergency, I authorise any qualified person to administer necessary treatment, medical or surgical including the administration of blood and blood products.

I agree to completing any on-line training, briefings or other information as required by S100 MCC and/or the ACUE.

The above answers are truthful and correct.

I have not been prevented on medical grounds, from taking part in any other sport.
I do not take any prohibited substances and/or methods as per the WADA list and I do not misuse alcohol or drugs.

In case of injury/illness I give permission for the Chief Medical Officer or her Deputy, to release any relevant information to the Clerk of the Course, my relatives, my representatives, the Rider’s Welfare Officer and to any other doctors involved in my care.

I confirm that since my previous application, there have been no changes in my health including mental health, wellbeing, illness or injury.

I will immediately inform the ACU and/or the CMO/DCMO of Southern 100 MCC in the event of any changes in my health including mental health, wellbeing, illness or injury.

I agree to the details of my medical history being sent to the CMO/DCMO of Manx Roadracing Medical Services as part of my licence application.

In case of emergency, I authorise any qualified person to administer necessary treatment, medical or surgical including the administration of blood and blood products.

I agree to completing any on-line training, briefings or other information as required by S100 MCC and/or the ACUE.

I/we hereby apply to enter the race(s) indicated below and declare that the motorcycle I/we enter complies in every detail with the regulations and that the thereof are correct. The appropriate entry fee is enclosed

I hereby declare that I have had the opportunity to read, and that I understand the National Sporting Code of the ACU, the ACU Standing Regulations, such Supplementary Regulations as have or may be issued for the event, and agree to be bound by them.

I declare that I am physically and mentally fit to take part in the event and I am competent to do so. I confirm that I understand the nature and type of event I am entering and its inherent risks and agree to accept the same notwithstanding that such risks may involve negligence on the part of the Organisers or Officials.

I confirm that I am not currently suspended from ACU permitted competition nor on the ACU Stop List as a result of incurring a Concussion/Suspected Concussion Injury.

I accept that insurance arranged on my behalf by the organisers of events that I may enter specifically excludes liability between the participants. I understand that this form may be used in litigation as evidence that any serious injury will be principally the result of my voluntary decision to engage in a high-risk activity.

I consent to details of any injuries I may suffer at this event being passed between all medical services and the Clerk of the Course.

I consent to the collection and retention of my personal information by the ACU and the Southern 100 Motorcycle Racing Ltd.

I confirm that the machine(s) as described on page 2 which I shall participate on shall be suitable and proper for the purpose. I confirm that I am eligible to compete on the machines for which I have entered.

I confirm that if any part of the event takes place on a public highway, the machine(s) described on page 2 shall be insured as required by the Road Traffic Acts, or equivalent legislation, and that they will comply with the regulations in respect thereof.

I accept responsibility for any items borrowed from the Organiser during the event. These items include but are not restricted to (safety clothing, transponders, and accessories). I understand that I am liable for the cost or replacement of any items lost or not returned and non-payment or non-replacement of items borrowed may affect my entry into subsequent events.

I confirm that I have not been refused an ACU Licence, not had an ACU Licence suspended, nor have I been excluded from any ACU Competition.

I have read and understood The Auto Cycle Union Ltd Data Protection Policy and consent to the collection and retention of my personal information by the ACU.

I accept that this entry, if accepted, will form a contract between the Club and myself, which will be governed in all respects in accordance with Isle of Man Law. I/we irrevocably submit to the jurisdiction on the Isle of Man Courts in respect of any legal action or proceedings arising out of the contract or my participation in the meeting.

I understand that by taking part in this event I am exposed to a risk of death, becoming permanently disabled or suffering some other serious injury and I acknowledge that even in the event that negligence on the part of the ACU, any event organiser, any circuit owner, the Promoter, the organising club, the venue owner, or any individual carrying out duties on their behalf were to be a contributory cause of any serious injury I may suffer, the dominant cause of any serious injury will always be my voluntary decision to take part in a high risk activity.