Firefly Novice Rally 2017 Internet Entry Form

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

Welcome to the John Roberts Auto Services Firefly Novice Rally Online Entry System. Please read the details below and follow instructions on how to enter the event. Entries open from 18:00 hrs on date stated above. We look forward to receiving  your entry and if you have any questions please  contact a member of the organising team

Entries Close for seeding on 13th May 2017 at 17.00hrs

Nia Jones

Gorsedd farm

Gorsedd

Holywell

Flintshire

CH8 8QZ

Email: ninswyn@outlook.com
Home: 01352 717980
Mobile: 07777659186
Between 7pm and 9pm

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 Firefly Novice Rally Online Entry system. Please follow the steps below to enter the rally.

  1. Complete ALLthe 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 two 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 HSBC
      Sort Code 40-17-14
      Account No. 52036479
      Account Name Broughton - Bretton Motor Club
      Reference Driver's full name.
    2. Or you can send a cheque, made payable to 'Broughton - Bretton Motor Club Ltd' to the Entries Secretary at the address above 
  4. Within 48 hours of us receiving full 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 after 7 days of submitting an entry we haven't recived your payment we will contact you as a reminder
  5. If you don't receive a response within 5 days of the expected payment date, or if you have any other questions, please e-mail ninswyn@outlook.com

    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 COMPLETE AS MUCH OF THE ENTRY FORM AS POSSIBLE TO SAVE TIME ON THE NIGHT - IF WE RECEIVE AN ENTRY WITH A LACK OF DETAILS WE WILL CONTACT YOU FOR THE REST AND YOUR ENTRY MAY NOT BE DEEMED TO BE ACCEPTED UNTIL WE HAVE RECEIVED THOSE DETAILS
Document Addressing
E-Mail address for communication
Real Name of this person
Whom should we send Finals and Results to?
Event Finals and Results will be available to download and will also be emailed to the address provided. If you would like a paper set posted to yourself please let us know here
Driver
Full Name
Address
Post Code
Home Town
Telephone Number
Mobile Number
E-Mail Address
Date of Birth
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
E-Mail Address
Date of Birth
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
Class
Insurance - Please Complete in Full
Insurers Name & Your Policy Number
If you are using the Jelf On Event Insurance Scheme please state Jelf otherwise please complete in full
Insurance Company's Address
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 ClubYearTypeOverall PositionNo of Starters
Fees - see above for how to pay
£70 which includes 2 x breakfasts £
Closed to club event. Please choose number of memberships required. £
Please read below insurance conditions before selecting required option!

The Organisers have applied to Jelf Insurance Partnership for a Blanket Cover Note under the above scheme. This will provide competitors who need to use the scheme with the Third Party Cover necessary to meet RTA requirements on the Road Sections of the event.

If using JELF the basic rate for the event before any loadings will be £15.55 . All applicants wishing to use the scheme must be able to comply with all points of the Jelf Insurance Partnership’s Declaration: -

  • I do not have the Third Party Road Section extension on my current Motor Insurance.

  • I am aged 20 or over.

  • I have had no more than 1 fault claim in the last three years

  • I have no more than maximum of 6 conviction points on my UK driving licence

  • I have the appropriate competition/club membership licence as well as a UK/EU driving license and if my license is provisional I will be supervised by an adult over 25.

  • I have no physical or mental disabilities

  • I have no other material facts to disclose

  • Anyone aged less than 20 years old will also be accepted at the same price should their co-driver be a more senior member of their family or over 25.

If you comply with all points above no Letter of Acceptance will be required. If unable to comply with any of the above points you will be required to complete the Declaration form (the form can be obtained by contacting the event secretary or Jelf Insurance Partnership) which should be forwarded either to the organisers or direct to Jelf

£
Total Money to be sent£
Payment Method and Details
Marshal Details
Name
Address
Post Code
Telephone Number
Mobile Number
Email Address
Experience
Comments
Very Important notice

 

 

Any entry made by a person under the age of 18 years as a driver or navigator must be made with a fully completed and submitted MSA parental consent form. This form must be filled in by a parent or guardian and returned to the entries secretary before the start of the event. Form can be obtained using the link below.

https://www.msauk.org/assets/parentalconsentauthorisation-1.pdf

In the comments box provided please state your preferred control type (time or passage control)?

Please also indicate your control time preference, ie early, middle or late?

Please also state if your marshal is available to cover more than one control ?

Please note we cannot guarentee we can meet your preference requirements!

Remember you will not be allowed to start if your marshal has not signed on and no refund will be given!

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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