5 Star Stages Internet Entry Form

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

Entries Close for seeding on 30th April at 12:00

Entries Secretary: Michelle Park

13 Burnock Street

Ochiltree

East Ayrshire

KA18 2NP

e-mail: michelle@eastayrshirecc.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 the EACC May Rally & Junior Rally Online Entry system. Please follow the steps below to enter the rally.

Complete all the fields in the form below. The fields with red backgrounds are mandatory.
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.

There are then three ways to pay

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. Paying by Paypal will incur a 4% fee, which is added on to the total due.

If you have internet or telephone banking, you can arrange for the fees to be paid directly into our account. The details are:-

Bank	Bank of Scotland
Sort Code	80-12-39
Account No.	00301201
Account Name	East Ayrshire Car Club
Reference	Driver's full name.

You can send a cheque made payable to 'East Ayrshire Car Club' to the Entries Secretary at the address above.

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 michelle@eastayrshirecc.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
Co-Driver

How would you like to receive Finals and Results?

E-mail/Website

Driver

Full Name

Address

Post Code

Home Town

Telephone Number

Mobile Number

Competition Licence Number

Competition Licence Issuer

E-Mail Address

Club

Date of Birth

Nationality

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

Competition Licence Issuer

E-Mail Address

Club

Date of Birth

Nationality

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

No
Yes

Four Wheel Drive

No
Yes

Class

Class J1K - Ecosse J1000 Registered Competitors
Class 0 - Cars upto 1000cc
Class 1 - Cars between 1001cc and 1400cc
Class 2 - Cars between 1401cc and 1700cc
Class 3 - Cars between 1701cc and 2100cc
Class 4 - Cars over 2100cc and all turbo cars

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

Lawrence of Kemnay Junior 1000 Ecosse Challenge 2017

Crew Members Registered

None
Driver
Co-Driver
Both

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 Club	Year	Type	Surface	Overall Position	No of Starters

Fees - see above for how to pay

Entry Fee

Total Money to be sent

Payment Method and Details

PayPal
BACS
Cheque

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.

Declaration by Competitors

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.
I understand that motorsport can be 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 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 including but not limited to damage to property, economic loss, consequential loss or financial loss howsoever caused. 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 this 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 this entry relates and that the vehicle entered is suitable and roadworthy for the event having regard to the course and the speeds which will be reached'.
If I am the Parent or Guardian 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 ‘I confirm that I have acquainted myself and the minor with the MSA General Regulations, agree to pay any 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 maxima set out in Part 3, Appendix 1.’
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 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. 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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