Clitheronian Rally 2017 Internet Entry Form

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

Entries Close for seeding on 18th September at 24:00hrs

 

c/o 112 Southwood Drive

Baxenden

Accrington

Lancashire

BB5 2TU

Tel 07850 100917

email: alexandramarie@hotmail.co.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 Clitheronian Rally 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 would like to pay via credit or debit card, you will get a link at this point to take you to Paypal's website, where you can pay for your entry by card. Note that we do not see your card details at all, this is all handled for us by Paypal.
    2. If you have internet or telephone banking, you can arrange for the fees to be paid directly into our account. The details are:-
      Bank Lloyds Bank
      Sort Code 30-90-87
      Account No. 02578114
      Account Name The Clitheronian Rally
      Reference Driver's full name.
    3. You can send a cheque, made payable to 'The Clitheronian Rally' to the Entries Secretary at the address above
  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@clitheronian.co.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.

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
Telephone Number
Mobile Number
Competition Licence Number
E-Mail Address
Club
Navigator
Full Name
Address
Post Code
Telephone Number
Mobile Number
Competition Licence Number
E-Mail Address
Club
Car
Make
Model
Colour
Registration Number
Engine Capacity
Class
Insurers
Name
Address
Sponsor
Sponsor Name (Note: this sponsor does not need an entrant's licence.
If you have an entrant with an entrant's licence,
please give details later.
Championships
Gazzard Accounts SD34 Road Rally Championship
Crew Members Registered
Al I Harrison KLMC Road Rally Championship
Crew Members Registered
Association of Northern Car Clubs Championship
Crew Members Registered
Association of North Western Car Clubs Championship
Crew Members Registered
Association of North East Midlands Car Clubs Championship
Crew Members Registered
HRCR Premiere Championship
Crew Members Registered
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 Road Rallies
Event Name and ClubYearTypeOverall PositionNo of Starters
Seeding - Competitor Opinion
Out of 50 entries, where do you think you should be seeded?
Fees - see above for how to pay
Entry Fee £
Club Membership £
Insurance £
Optional Donation to North West Air Ambulance Charity£
Total Money to be sent£
Payment Method and Details
Entrant (if applicable and not driver)
Name
Address
Post Code
Telephone Number
Competition Licence Number
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.

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.."

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