Jackson Trophy Rally 2017 Internet Entry Form

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

The Jackson Trophy Rally
17th - 18th June 2017 
Entries Close on 14th June

Entries Secretary: Nicola Mansell
4 Mount Pleasant Road,
Grindleford,
Hope Valley,
S32 2JE

Telephone: 01433 631544 / 07795 026963
E-Mail: entries.jackson@sh-mc.co.uk

 

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

Welcome to the 2017 Jackson Trophy 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 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 Yorkshire Bank
      Sort Code 05-08-18
      Account No. 33223113
      Account Name Sheffield & Hallamshire Motor Club
      Reference Driver's full name.
    2. You can send a cheque, made payable to 'Sheffield & Hallamshire Motor Club Ltd' to the Entries Secretary at the address above.
  4. Within 24-48 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.jackson@sh-mc.co.uk
  6. 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?
How would you like to receive Finals and Results?
Driver
Full Name
Address
Post Code
Telephone Number
Mobile Number
Competition Licence Number
E-Mail Address
Club
Date of Birth
Driver's Parent or Guardian (under 18 only)
Name
Address (if different)
Post Code
Telephone Number
Relationship
Navigator
Full Name
Address
Post Code
Telephone Number
Mobile Number
Competition Licence Number
E-Mail Address
Club
Date of Birth
Navigator'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
Insurers

If using your own insurers please state the name and policy number

Name
Address
Championships
East Midland Association of Motor Clubs
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Association of North East Midlands Motor Clubs
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Association of Northern Car Clubs
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 Navigator
Name
Address
Post Code
Telephone Number
Relationship
Will this person be attending the event?
Seeding - Past Performance on Rallies

Please indicate D or N to differentiate between results for Driver or Navigator

Event Name and ClubYearEvent StatusOverall PositionClass Position
Fees - see above for how to pay
Entry Fee (Including two breakfasts) £
Club Membership £
Insurance £
Donation to the Multiple Sclerosis Therapy Centre South Yorks.£
Total Money to be sent£
Payment Method and Details
Marshals are always required to help the event run successfully. If you know anyone willing to help please provide details.
Name
Address
Post Code
Telephone Number
Mobile Number
Email Address
Experience
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 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 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 (as amended). 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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