Cambell Contracts Rally Time Trial 2015 Internet Entry Form

Entries to this event are now closed and this page is for record only

Entries Close for seeding on 1st October 2015 at 00:00 hours

Entries Secretary: Jackie Elliott 

Jackie Elliott

47 Grogey Road,

Fivemiletown,

County Tyrone,

BT75 0SJ

Phone:07884 074168

Email: jackie.elliott1@yahoo.co.uk 

Held under the General Regulations of the Motor Sports Association (incorporating the provisions of the International Sporting Code of the FIA) and these Supplementary Regulations

Welcome to The Campbell Contracts rally time trial 2015 Online Entry system. Please follow the steps below to enter the rally.

 

  1. Complete all the fields in the form below. The fields with red backgrounds are mandatory.
  2. Once you have hit the "Enter the Rally" button at the end you will receive an automated response confirming we have received your entry form.
  3. There are then three ways to pay.

 

 

  1. If you have internet or telephone banking, you can arrange for the fees to be paid directly into our account. The details are:-
    Bank Danske Bank
    Sort Code 95-03-09
    Account Number 51045296
    IBAN GB47DABA95030951045296
    Swift DABAGB2B
    Account Name Enniskillen Motor Club Ltd
    Reference Driver's full name.

2) by posting a cheque to the event secretary. Cheques payable to: Enniskillen Motor Club Ltd

3) or by paying with worldpay (Please note that there is a 2% surcharge on credit/debit card payments).

 

        Within 24 hours of us receiving the payment for your entry, you should receive an e-mail confirming your entry from the Entries Secretary.

      NOTE: WITHOUT PAYMENT YOUR ENTRY WILL NOT BE VALID.

        If you don't receive a response within 3 days of the expected payment date, or if you have any other questions, please e-mail ronancoxrallying@yahoo.ie

All the fields with a red background must be filled in, or you will not be able to continue. Please put TBA in any red field which you do not know the details for.

Document Addressing
E-Mail address for communication
Real Name of this person
Whom should we send Finals and Results to?
Driver 1
Full Name
Address
Post Code
Contact Number
Competition Licence Number
Competition Licence Issuer
E-Mail Address
Club
Date of Birth
Driver's Parent or Guardian (under 18 only)
Name
Address (if different)
Post Code
Telephone Number
Relationship
Driver 2 (dual entry)
Full Name
Address
Post Code
Contact Number
Competition Licence Number
Competition Licence Issuer
E-Mail Address
Club
Date of Birth
Navigator's Parent or Guardian (under 18 only)
Name
Address (if different)
Post Code
Telephone Number
Relationship
Car
Make
Model
Registration Number
Engine Capacity
Year
MOT/NCT

 

 

I declare that my vehicle has current MOT/NCT

Dual Entry

 

 

 

 

 

Class

 

Rotary engine cars - class determined by capacity x 2

Turbo engine cars - class determined by capacity x 1.7

 

Person to be contacted in case of serious accident to Driver
Name
Address
Post Code
Telephone Number
Relationship
Person to be contacted in case of serious accident to Driver 2
Name
Address
Post Code
Telephone Number
Relationship
Seeding - Past Performance on Rallies Driver 

Spaces 1-3 Driver 1

Spaces 4-6 Driver 2 (Dual entry)

Event Name and ClubOverall PositionClass Position
Fees - see above for how to pay
Entry Fee £
Club Membership £
Total Money to be sent£
Payment Method and Details
Entrant (if applicable and not driver)
Name
Address
Post Code
Telephone Number

The details on this form will be held on computer in order to be used for the administration of this event. They will also be used to send you information about future events organised by this club, unless you untick this box to indicate you do not wish to receive information on further events.
The details on this form may also be passed on to other motorsport organisations, unless you untick this box to indicate you do not wish these details passed on.

By clicking on the "Enter the Rally" button below you agree to the following: 

DECLARATION OF INDEMNITY:
By the very fact of signing the entry form, the entrant, as well as the crew members submits
themselves to the sporting jurisdictions specified in the International Sporting Code of the FIA
and accept unreservedly these regulations, the General Regulations of the Motor Sports
Association (MSA).
“I declare that I have been given the opportunity to read the General Regulations of the Motor
Sports Association and if any the Supplementary Regulations for this event and agree to be
bound by them. I declare that I am physically and mentally fit and competent to take part in the event I understand that motorsport is dangerous and accidents causing death, injury, disability and property damage can and do happen. I understand that these risks may give rise to my suffering personal injury or other loss and I acknowledge and accept these risks.”
“In consideration of the acceptance of this entry I agree that neither any one of or any combination of the MSA and its associated clubs, the organisers, the track/land owners or other occupiers, the promoters and their respective officers, servants, representatives and agents (the “Parties”) shall have any liability for loss or damage which may be sustained or incurred by me as a result of participation in the Event. Nothing in this clause is intended to or shall be deemed to exclude or limit liability for death or personal injury. To the fullest extent permitted by law I agree to indemnify and hold harmless each of the Parties in respect of any loss or damage whatsoever and howsoever arising from my participation in the Event.
“I declare That to the best of my belief the driver(s) possess (es) the standard of competence necessary for an event of the type to which the entry relates and the vehicle entered is suitable and roadworthy for the event having regard to the course and the speeds which will be reached.”
STATE YOUR AGE IF YOU ARE UNDER 18:(in appropriate section for the form)
“I declare that the use of the vehicle hereby entered will be covered by insurance as required by the law which is valid for such part of the event as shall take place on roads as defined by the law.”
“I understand that should I at the time of this event be suffering from any disability whether permanent or temporary which is likely to affect prejudicially my normal control of my vehicle, I may not take part unless I have declared such disability to the ASN which has, following such declaration issued a licence which permits me to do so.”
“I undertake that at the time of the event to which this entry relates I shall have passed or am exempt from an ASN specified medical examination within the specified period ”, if required. (H.10.1.6)
If I am the Parent/Guardian/Guarantor of the driver
“I understand that I shall have the right to be present during any procedure being carried out under the Supplementary Regulations issued for this event and the General Regulations of the MSA. As the Parent/Guardian/Guarantor I confirm that I have acquainted myself and the minor with the MSA General Regulations, and agree to pay and appropriate charges and fees pursuant to those Regulations (to include any appendices thereto) and hereby agree to be bound by those Regulations and submit myself without reserve to the consequences resulting from those Regulations (and any subsequent alteration thereof). Further, I agree to pay as liquidated damages any fines imposed upon me up to the maximum set out in Part 3, Appendix 1.”
Note: Where the Parent is not present there must be a Guardian who must produce a written and signed authorisation from the Parent/Guardian to act as their representative.
“I understand that should I at the time of this event be suffering from any disability whether permanent or temporary which is likely to affect prejudicially my normal control of my vehicle, I may not take part unless I have declared such disability to the ASN which has following such declaration, issued a licence which permits me to do so.”
“I undertake that at the time of the event to which this entry relates I shall have passed or am exempt from an ASN specified medical examination within the specified period ”, if required. (H.10.1.6)
“I have read and fully understood the Procedure for Control of Drugs and Alcohol as contained in the Competitors’ and Officials’ Yearbook Regulations H39, D35.1, G15.1.4, and have also fully familiarised myself with the information on the web sites referred to (www.ukad.org.uk and www.wada-ama.org) in particular the UK Anti Doping Rules which have been adopted by the MSA (as amended). Further, if I am counter-signing as the Parent or Guardian of a minor then in addition to the deemed consent to the testing of that minor (UKAD Code Art 5.6.2) I hereby confirm that I give such consent for the minor concerned to be so tested.”
“I hereby agree to abide by the MSA Child Protection Policy and Guidelines and the National Sporting Code of Conduct.”

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