PHOTO 2015 GMP Scotland Driver’s Licence Application ORCi Ministox Licence Expires: Licence Fee: 31st December 2015 £55.00 (This fee is universal to all ORC Circuits in 2015) All cheques made payable to Innovate Ltd. Return to GMP @ 73 Deanswood Park, Livingston EH54 8NY. A passport photograph must be supplied before each license is issued. SECTION A Surname: ____________________ Forename(s): ____________________ Age (Years): ____________________ Date of Birth: (If under 16yrs, please complete section “B”) ____________________ Address: __________________________________________________________ Town: ____________________ Postcode: ____________________ Area/County:____________________ Telephone Numbers Home: ____________________ Work: ____________________ Mobile: ____________________ Formula: ____________________ Racing No’: ____________________ If you did not race last season, please state racing number requested: ________ Have you ever raced any oval formula OTHER than that for which you are applying to race? (Please circle) Yes No If Yes, state formula: ____________________Last grade held: ________________ Date last raced: ____________________ Race No’: ______________________ (The above grade will be the grade in which you return to racing unless you wish to appeal in writing.) Mechanics licenses required @ £40 each (Max 2): _____ CONTINUED ON NEXT PAGE Please answer Yes or No (circle) to the following questions: Do you suffer from epilepsy or attacks of fainting? Yes No Are you without either hand or foot or suffer any restriction of movement? Yes No Do you suffer from any disease or disability which could be a danger to yourself or others? Yes No Can you read a car registration at 25Yds? Yes No Are you colour blind? Yes No Declaration I declare to the best of my knowledge and belief that the above answers are true. I understand that it is an offence to drive a Stock Car or compete in a Stock Car Meeting on a track not recognised and licensed by the ORCi. I further understand that if a license is granted it is obligatory to study and understand the Official Regulations that govern Stock Car racing and that no legal action can be taken against the Association or its officials on any decision or any matter connected with Stock Car racing under the Oval Racing Council International Regulations Signature: ____________________ Date: ____________________ SECTION B: For drivers aged under 16 years of age. To be completed by Parent /Guardian. I hereby consent to permit the above named juvenile to compete in stock car racing events promoted by GMP Scotland and other associated tracks and understand that no liability is carried by the promoting company at these events. I am the legal *Parent/ Guardian of the above juvenile. * Delete where appropriate. Signature: ____________________ Name in block letters: ____________________ ***************************************************************************************************** No liability is accepted by the promoting company arising from any occurrence at a GMP meeting. ***************************************************************************************************** Office only. Do not write below this point. Formula: Mechanics: Race No: Paid : Cheque / cash