Formulário de Inscrição

A Confederação Brasileira de Automobilismo (CBA), Federação de Automobilismo do Estado de Santa Catarina (FAUESC).

Com o presente, eu abaixo assinado, inscrevendo-me como CONCORRENTE/CONDUTOR na prova em referências, a

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DECLARO:

1 - Que estou ciente e que cumprirei fielmente os termos do Código Desportivo do Automobilismo (CDA) e do Regulamento Particular da Prova;

2 - Que me comprometo a não recorrer aos Poderes Públicos, e sim, unicamente aos Poderes Desportivos legalmente constituídos, de qualquer decisão adotada;

3 - Que nenhum direito terei à devolução da importância paga no ato da inscrição, sob qualquer hipótese;

4 - Me responsabilizo pelo cuidado e atenção com o sensor de cronometragem, sob pena de ressarcimento em caso de perda ou dano; (3 UP`S);

5 - Que nenhuma responsabilidade, sob qualquer título, terá a CBA - CONFEDERAÇÃO BRASILEIRA DE AUTOMOBILISMO, a FAUESC - FEDERAÇÃO DE AUTOMOBILISMO DO ESTADO DE SANTA CATARINA, seja em virtude de acidentes com danos pessoas e/ou materiais que eventualmente venham a ocorrer, bem como, por acidentes ou prejuízos por mim causados a terceiros ou a organização, pelos quais, desde já, assumo total responsabilidade.

Declaro ainda que todos os meus equipamentos de segurança são homologados, estão em perfeito estado de conservação, dentro da validade e que os usarei conforme determina a CBA e o Regulamento da Prova/Campeonato.

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CPF:

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Nº MATRÍCULA CBA:

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NÚMERO DO CARRO:

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PLANO DE SAÚDE:

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CONTATO DE EMERGÊNCIA:

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CATEGORIA(S) INSCRITA(S):

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