Mercian Road Rally 2017/Mercian Clubmans Rally Internet Entry Form

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

Entries Close for seeding on Monday 11th September 2017 at midnight.

Cyril Loman. Mercian Road Rally Entries Secretary
54 Ettington Close
Wellesbourne
WARWICK
CV35 9RJ

Tel: 07768 275752
Email: c.a.r.l@btinternet.com

The entry list may remain open after 11th September at the discretion of the organisers. Later entries may need to be seeded lower and wherever space is available.

The event is held under the General Regulations of the Motor Sports Association (incorporating the provisions of the International Sporting Code of the FIA), the Supplementary Regulations and any written instructions the organising club may issue for the event.

We need a large number of marshals for this event. Please try to encourage friends, family and members of your motor club to volunteer.
Their efforts and your encouragement will be appreciated. Thank you.

Welcome to the Mercian Road 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 then two ways to pay
    1. PREFERRED :
      If you have internet or telephone banking, you can arrange for the fees to be paid directly into our account. The details are:
      Sort Code 77-07-14
      Account No. 06514360
      Account Name Mercia Motor Sports
      Reference Driver's full name
      or
    2. You can send a cheque, made payable to 'Mercia Motor Sports' to the Entries Secretary at the address above.

      4.  When we have received the payment for your entry you will receive an email confirming your entry from the Entries Secretary.

       Note: Without payment and subject to the procedure in the regulations, your entry will not be officially accepted.

      5.  If you don't receive a response within 3 days, or if you have any other questions, please contact the Entries Secretary.

      6. All the fields with a red background must contain a response from you or you will not be able to continue.

Please put TBA in any red field ONLY where you do not know the details, and confirm any missing information to the Entries Secretary as soon as possible.
You will not be able to edit your entry at a later date, so please provide as much information as possible now to avoid causing additional work for the organisers and delays at signing-on.

Document Addressing
E-Mail address for communication
Real Name of this person
Whom should we send Finals and Results to?
Driver
Full Name
Address
Post Code
Telephone Number
Mobile Number (or main number if no mobile)
Competition Licence Number
E-Mail Address
Club
Age if under 18
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 (or main number if no mobile)
Competition Licence Number
E-Mail Address
Club
Age if under 18
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
Class
Insurers
Name
Address
Inter-Association Team
Inter-Association Team
Championships
AWMMC Mr Tyre Motorsport Road Rally Championship
Crew Members Registered
EMAMC AB Motorsport Road Rally Championship
Crew Members Registered
ANEMMC Drury Deliveries Road Rally Championship
Crew Members Registered
HRCR Premier Rally Championship
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 Navigator
Name
Address
Post Code
Telephone Number
Relationship
Will this person be attending the event?
Navigator's Seeding Information - Past Performance on Rallies
Event Name and ClubYearTypeOverall PositionNo of Starters
Seeding - Competitor Opinion
Out of 55 entries, where do you think you should be seeded?
Fees - see above for how to pay
Entry Fee £
Club Membership £
Insurance £
Donation to the Warwickshire and Northamptonshire Air Ambulance£
Total Money to be sent£
Payment Method and Details
Marshal Details:

We need a large number of marshals for this event. Please try to encourage friends, family and members of your motor club to volunteer.

WITHOUT  ADEQUATE  MARSHALS  WE CANNOT  RUN  THE  EVENT!

With this in mind we ask that all crews please nominate a marshal now. Their efforts and your encouragement will be appreciated.

Name
Telephone Number
Mobile Number
Email Address
Experience (Time Control/Passage Control)
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.

By clicking on the 'Agree to the declaration and Enter the Event' button below you agree to the following:

If I wish to purchase REIS insurance cover for this event via the organisers and am unable to comply with the requirements listed in the Supplementary Regulations, I will contact the Entries Secretary at least 14 days before the event.

I agree that my details may be passed to the official event photographer for contact purposes.

Declaration of Indemnity

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.

I understand that motorsport can be 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 including but not limited to damage to property, economic loss, consequential loss or financial loss howsoever caused. 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 this 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 declare that the use of the vehicle hereby entered will be covered by insurance as required by the law which is valid for such part of this event as shall take place on roads as defined by the law.
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. 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.

Young Persons Form

If the driver or navigator is under the age of 18 this form must be counter-signed by that person’s parent or guardian.

If I am the Parent or Guardian 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, 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 thereof). Further, I agree to pay as liquidated damages any fines imposed upon me up to the maxima set out in Part 3, Appendix 1.

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