John Overend Memorial Stages Rally 2017 Internet Entry Form

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

Entries Close for seeding on Saturday 6th May 2017 at 12noon.

Entries Secretary: Alan Gilbert
6 Rowan Avenue
Beverley
HU17 9UN

Telephone: 07867 655557
e-mail: jomsr.entries@northhumbersidemotorclub.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 John Overend Memorial Stages Rally 2017 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 4 ways to pay:
    Scheme A - Full Payment by cheque (before Saturday 6th May 2017);
    Scheme B - 2 cheques (1 cheque for £85, dated as entry, plus 1 cheque for the outstanding balance dated on or before Saturday 6th May 2017),
    N.B. All cheques should be made payable to 'North Humberside Motor Club Ltd' and sent to the Entries Secretary at the address above. Please write the drivers name on the rear of the cheque(s)
    Scheme C - Direct  transfer to the 'North Humberside Motor Club' HSBC Bank Account - Sort Code 40-22-13 and a/c number 61043072 (on or before 12 noon on Saturday 6th May 2017). Please use the Drivers first name and surname as the reference.
    Scheme D - Two Direct Transfers to the 'North Humberside Motor Club' HSBC Bank Account - Sort Code 40-22-13 and a/c number 61043072. (one for £85, made as soon as possible, plus one for the outstanding balance to be made on or before 12 noon on Saturday 6th May 2017) Please use the Drivers first name and surname as the reference
  4. Within 24 hours of our 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: jomsr.entries@northhumbersidemotorclub.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?
How would you like to receive Finals and Results?
Driver
Full Name
Address
Post Code
Home Town
Telephone Number
Mobile Number
MSA Competition Licence Number
E-Mail Address
Club
Date of Birth (If under 18)
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
MSA Competition Licence Number
E-Mail Address
Club
Date of Birth (If under 18)
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 or Rotary engine
Four Wheel Drive
Class
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.
Eligibility
The 2017 Roadrunner Phoenix Awards ANEMMC Stage Rally Championship
Crew Members Registered
The 2017 Alexander Calder Financial EMAMC Stage Rally Championship
Crew Members Registered
The 2017 CHONKA MOT ANCC Stage Rally Championship & Legend Fires Ladies Cup
Crew Members Registered
The 2017 Melbourne Challenge
Crew Members Registered
The ANWCC Stage Rally Championship 2017
Crew Members Registered
North Humberside Motor Club Crew award (see S/R 13 for eligibility)
Crew Members Registered
Mixed Crew Award
Crew Members Registered
Female Driver Award
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 Rallies
Event Name and ClubYearTypeSurfaceOverall PositionPosition in Class
Seeding - Competitor Opinion
Out of 65 entries, where do you think you should be seeded?
Scrutineering
When would you prefer to scrutineer? Saturday 13th May - 16:00 to 18:30
Sunday 14th May - 06:00 to 08:00
Fees - see above for how to pay
Entry Fee £
Club Membership £
Phil & Marcus Andrews Photo Offer A @ £12.00 (see SR32)£
Phil & Marcus Andrews Photo Offer B @ £15.00 (see SR32)£
Donation to the Marshals Fund£
Total Money to be sent£
Payment Method and Details (Scheme A; Scheme B; Scheme C or Scheme D - see above)
Entrant (if applicable and not driver)
Name
Address
Post Code
Telephone Number
Nationality
MSA Competition Licence Number
Marshal Details - if you know of a marshal who'd like to come and help, please give details here
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 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.

If I am the Parent/Guardian/Guarantor 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/Guarantor ‘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 thereto). Furthermore, I agree to pay as liquidated damages any fines imposed upon me up to the maxima set out in Part 3 Appendix 1.

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".

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