The Rex Pet Hotel Flying Fortress Stages 2017 Internet Entry Form

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

Entries will be seeded on THURSDAY 8th JUNE

Entries finally close Thursday 15th June

Entries Secretary: Bob Draper

63 Kirkby Folly Road, Sutton in Ashfield. Notts NG17 5HP

Telephone 01623 511733 (Evenings after 7.00pm and before 9.00pm Only)

e-mail: entries@flyingfortressstages.co.uk

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

The Rex Pet Hotel

Flying Fortress Stages Rally

Sunday 18th June 2017

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 and must be filled in otherwise you will not be able to continue.
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 two ways to pay

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

Bank	Co-operative Bank
Sort Code	08-92-99
Account No.	65342240
Account Name	Dukeries MC Events Account
Reference	Driver's First name and Surname

OR you can use PayPal by visiting the Competitor page of the event website. www.flyingfortressstages.co.uk (PayPal admin charges are included)

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

PLEASE NOTE: WITHOUT PAYMENT YOUR ENTRY WILL NOT BE COMPLETE and you will NOT APPEAR on the LIST of ACCEPTED ENTRIES.

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@flyingfortressstages.co.uk

Please put TBC in any red field which you do not know the details for.

Document Addressing

E-Mail address for communication.

Without a functioning e-mail address we cannot contact you and send event info.

Please supply a valid address.

Real Name of this person

Whom should we send Final Instructions to?

Driver
Co-Driver

Driver

Full Name

Address

Post Code

Contact Telephone Number

Competition Licence Number

E-Mail Address

Club

Driver's Parent or Guardian (under 18 only)

Name

Address (if different)

Post Code

Telephone Number

Relationship

Co-Driver

Full Name

Address

Post Code

Contact Telephone Number

Competition Licence Number

E-Mail Address

Club

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

Forced Induction

No
Yes

Four Wheel Drive

No
Yes

Class

0 - Class 0 - Cars up to & including 1000cc
1 - Class 1 - Cars over 1000cc up to & including 1400cc
2 - Class 2 - Cars over 1400cc & up to and including 1600cc
3 - Class 3 - Cars over 1600cc & up to and including 2000cc
4 - Class 4 - Cars over 2000cc - 2WD
5 - Class 5 - Cars over 2000cc - 4WD

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

Alexander Calder Financial EMAMC Stage Rally Championship

Crew Members Registered

None
Driver
Co-Driver
Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Roadrunner / Phoenix Awards ANEMMC Stage Rally Championship (supported by Pantry Catering & Slicks Tyres)

Crew Members Registered

None
Driver
Co-Driver
Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Jelf Motorsport.com Stage Rally Championship

Crew Members Registered

None
Driver
Co-Driver
Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Dukeries MC Championship

Crew Members Registered

None
Driver
Co-Driver
Both

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 Club	Year	Type	Surface	Overall Position	No of Starters

Seeding - Competitor Opinion

Out of 65 entries, where do you think you should be seeded?

Scrutineering Note:

When would you prefer to Scrutineer?

We will try and accommodate BUT NO Guarantees.

Saturday between 2.30pm and 5.30pm
Sunday between 7.30am and 8.15am

Fees - see above for how to pay

Entry Fee £240 - (£250 if using PayPal)

Dukeries MC Membership till 31/12/2017

Total Money to be sent

Payment Method - Indicate how you will be paying for your entry.

Bank Transfer
Paypal

Entrant (if applicable and not driver)

Name

Address

Post Code

Telephone Number

Competition Licence 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.

Remember your entry is subject to receipt of the correct entry fee. An automated acknowledgement is NOT confirmation of entry.

Reserve entries 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 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 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 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'.

‘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 hereby agree to abide by the MSA Child Protection Policy and guidelines and the National Code of Sporting Conduct'.

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