Keldine Autos Cheviot Stages Rally 2017 Internet Entry Form

Entries Close for seeding on 7th October at Noon

Entries Secretary: Gordon Bradford
13 Beverley Drive
Swalwell
Newcastle upon Tyne
NE16 3EH
Telephone 07412 107269
Fax
e-mail  entries@cheviotstages.org.uk

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

Welcome to the Keldine Autos Cheviot Stages Rally 2017, 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:-

    a.    You can send a cheque, or 2 cheques if paying in instalments,(cheque 1 for £150, Cheque 2 for the balance to be paid by 7th Oct) made payable to 'Cheviot  Rally' to the Entries Secretary at the address above.

    b.    If you have internet or telephone banking, you can arrange for the fees to be paid directly into our account.

    Bank: Barclays

    Sort Code: 20-62-09

    A/C No.: 60438472.

    c.    You can pay via PayPal

  4. 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.
  5. 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 entries@cheviotstages.org.uk 

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.

PLEASE NOTE The Chief Medical Officer has asked if you can fill in the Medical Declaration and send it off to him in strict confidence at:-   steven.miles75@btinternet.com

Document Addressing
E-Mail address for communication
Real Name of this person
Whom should we send Finals and Results to?
Driver
Full Name
Address
Post Code
Home Town
Telephone Number
Mobile Number
Competition Licence Number
E-Mail Address
Club
Nationality
Driver Publicity
Hobbies
Married?
No of Children
How Long Rallying?
Notable Results
Any other information
Driver's Parent or Guardian (under 18 only)
Name
Address (if different)
Post Code
Telephone Number
Relationship
Co-Driver
Full Name
Address
Post Code
Home Town
Telephone Number
Mobile Number
Competition Licence Number
E-Mail Address
Club
Nationality
Co-Driver Publicity
Hobbies
Married?
No of Children
How Long Rallying?
Notable Results
Any other information
Co-Driver's Parent or Guardian (under 18 only)
Name
Address (if different)
Post Code
Telephone Number
Relationship
Car
Make
Model
Colour
Registration Number
Engine Capacity
Year
Forced Induction
Four Wheel Drive
Class
In Car Camera Request
INSURANCE  If you wish to use our insurance, state "EVENT INSURANCE" If you have your own insurance, please state the name & address of your Insurance Company
Name 
Address
Championships
A S Performance North of England Tarmacadam Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
HRCR Old Stager Historic Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
ANCC Stage Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
HRCR Motoscope Northern Historic Asphalt Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Border Challenge Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Person to be contacted in case of serious accident to Driver
Name
Address
Post Code
Telephone Number
Relationship
Will this person be attending the event?
Person to be contacted in case of serious accident to Co-Driver
Name
Address
Post Code
Telephone Number
Relationship
Will this person be attending the event?
Seeding - Past Performance on Rallies
Event Name and ClubYearTypeSurfaceOverall PositionNo of Starters
Seeding - Competitor Opinion
Out of 100 entries, where do you think you should be seeded?
Fees - see above for how to pay
Entry Fee £
Club Membership £
Insurance £
Marshals donation£
Total Money to be sent£
Payment Method and Details
Entrant (if applicable and not driver)
Name
Address
Post Code
Telephone Number
Nationality
Competition Licence Number
Competition Licence Issuer
Comments
Anything else you'd like to tell us

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.

Remember your entry is subject to receipt of the correct entry fee. An automated acknowledgement is NOT confirmation of entry. Rejected entries and entries held in abeyance will be informed by e-mail to the address(es) given above.

By clicking on the "Enter the Rally" button below you agree to the following: "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 to take part in the event and I am competent to do so. I acknowledge that I understand the nature and type of the competition and the potential risk inherent with motor sport and agree to accept that risk. Further, I understand that all persons having any connection with the promotion and/or organisation and/or conduct of the event are insured against loss or injury caused through their negligence.."

Web Entries System provided by rallies.info