JRT Enville Stages 2017 Internet Entry Form

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

Entries Close for seeding on Wednesday 21st June 2017

Entries Secretary - Ann McCormack 99 Marina Village. Preston Brook, Runcorn, Cheshire WA7 3BH  (H) 01928 710546  (M) 07961086280

(E) warringtondmc@yahoo.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 JRT Motor Service Enville Stages 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. The entry fee is £250  payable either in full or in two instalments of an intial deposit of £100.00 dated as entry form and the second cheque to be dated 21st June 2017 for the balance of the total fees, after the 21st June 2017 the entry fee is payable in full only. Paypal will have a 4% surcharge.
  4. Within 24 hours of us receiving the payment or deposit  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. 
    Please remember, your entry is NOT accepted until we receive Deposit or FullPayment.
  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 warringtondmc@yahoo.co.uk

For payment, please either pay via BACS,  PayPal after clicking on Submit at the end of this form, or send a cheque payable to "Warrington & District Motor Club" to address above.

All the fields with a red background must be filled in, or you will not be able to continue. Please put TBC in any red field which you do not know the details for.

Document Addressing
E-Mail address for communication
Real Name of this person
Driver
Full Name
Address
Post Code
Home Town
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
Co-Driver
Full Name
Address
Post Code
Home Town
Telephone Number
Mobile Number
Competition Licence Number
E-Mail Address
Club
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
Forced Induction
Class
Service Vehicle
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
Association of North Western Car Clubs Championships 2017
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
SD(34) Motorsport Group Championships 2017
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
ANWCC North Wales Stage Rally Championship 2017
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 Co-Driver
Name
Address
Post Code
Telephone Number
Relationship
Will this person be attending the event?

Seeding - Past Performance on Stage Rallies by Driver Only
We can only seed you on the information you supply - please give as much detail as possible.

Event Name and ClubYearTypeSurfaceOverall Position

Class Position

Scrutineering
When would you prefer to scrutineer?
15.00 - 18.00
07.00 limited places contacted entries secretary
Fees - see above for how to pay
Entry Fee £
Club Membership £
Insurance £
Marshal Fund£
Total Money to be sent£
Payment Method and Details
Entrant (if applicable and not driver)
Name
Address
Post Code
Telephone Number
Competition Licence Number
Competition Licence Issuer
Marshal 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 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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