ENTRIES CLOSE 3 AUGUST 2025 Driver Personal DetailsName *Cell Number *Email Adress *Street Address123 Race AveCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweName & Surname - EMERGENCYCell Number - EMERGENCY *SA ID Number *Please fill in your South African ID numberSA Driver Licence Number *Please fill in your South African Drivers Licence numberVR Race Number *MSA Licence Number *Please fill in your MSA Licence number. If you do not have one please visit https://msaonline.co.za/Vehicle Details & ComplianceCar Make & Model *Vehicle Reg Number *Vehicle VIN Number *Class Selection *Please select an optionStreet FWDModified FWDStreet RWDModified RWDModified 4WDSuper ClassExhibitionPlease SelectPlease select your class for the event.Consent *The Medical Code contains the minimum Medical Standards that will be enforced at motorsport events. In addition, the Safety at Sport and Recreational Events Act (Act 2 of 2010), South African National Standard (SANS 10366), Emergency Medical Services Regulations and the Regulations Relating to Emergency Care at Mass Gathering Events are also required to be implemented during all eventshttps://msaonline.co.za/storage/uploads/files/rUy5x43anYXEMmgEu3nwsTvBvXeZgPeDEY1yxrYp.pdfConsent *Yes, I conform to the Vilaca Racing 2025 Rules and RegulationsConsent *Yes, I conform to the minimum lap time requirement from the Vilaca Racing 2025 Time Attack Championship of Round 1 - Red Star Raceway - 2:27:00 Round 2 - Zwartkops Raceway - 1:19:00Pit Crew MembersName & SurnameCell NumberEmail AdressName & SurnameCell NumberEmail AdressName & SurnameCell NumberEmail AdressName & SurnameCell NumberEmail AdressConsent *Yes, I confirm all the details above are correct Participant hereby warrants that Participant has read this Agreement carefully, understand its terms and conditions, acknowledge that Participant will be giving up substantial legal rights by submitting it, and intends for Participant submission to serve as confirmation of Participant’s complete and unconditional acceptance of the terms, conditions and provisions of this Agreement. This Agreement represents the complete understanding between Participant and the Event Organizers regarding these issues and no oral representations, statements or inducements have been made apart from this Agreement. If any portion of this Agreement is held to be unenforceable, invalid or overly broad, Participant agrees that the remaining terms and provisions of this Agreement will continue in full legal force and effect. Participant further understands and agrees to abide by the Rules and Regulations attached, which is incorporated herein by this reference.Additional NotesSUMBIT FORM