allglass Anglia Middlewick Stages Sunday 21 May 2017 Internet Entry Form

Entries Close for seeding on 

Thursday 18 May 2017

Entries Secretary: Irene Lewsey

Telephone 01245 329254 (Evenings before 9.30pm Only)

e-mail: entries@middlewickstages.org.uk

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

and the Supplementary Regulations

The allglass Anglia Middlewick Stages 2017

The Event is a Qualifying round of :-

The jelfmotorsport.com AEMC/ASEMC Stage Rally Championship

 

21st MAY 2016

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 Four 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 Natwest Bank
Sort Code 60-07-38
Account No. 04348257
Account Name GBMCWAC
Reference Driver's First Name and Surname

2. Pay cash (or cheque) into any branch of Nat West Bank, using the above details - please advise the Entries Secretary of the branch details if this method is used. 

3. Send a chequemade payable to 'GBMCWAC'  to the Entries Secretary at the address above.

4. Paypal  (this will cost an additional 4%)  

 

               PLEASE ENSURE YOU PUT THE DRIVERS NAME ON THE REVERSE OF THE CHEQUE FOR REFERENCE PURPOSES

               Within 24 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.

      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@middlewickstages.org.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
Telephone Number
Mobile Number
Competition Licence Number
E-Mail Address
Club
Age, if under 18 years
Driver's Parent or Guardian (under 18 only)
Name
Address (if different)
Post Code
Telephone Number
Relationship
Co-Driver
Full Name
Address
Post Code
Telephone Number
Mobile Number
Competition Licence Number
E-Mail Address
Club
Age, if under 18 years
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
Four Wheel Drive
Class
In Car Camera Request
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
The jelfmotorsport.com 2017 AEMC/ASEMC
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 PositionClass Position
Seeding - Competitor Opinion
Out of 50 entries, where do you think you should be seeded?
Scrutineering
When would you prefer to scrutineer? Saturday 20 May between 17.00pm and 19.30pm at Hotel
Sunday 21 May between 6.45am and 8.45am at venue
I confirm that the person paying the entry fee is a UK taxpayer and wishes the charity to reclaim tax on the donation detailed. That person understands that they must pay Income and/or Capital Gains Tax in the tax year at least equal to the amount of tax that all the charities and Community Amateur Sports Clubs to which he (she) donates will reclaim on their gifts for that tax year. They also understand that other taxes such as Council Tax and VAT do not qualify and that the charity will reclaim 25p of tax on every £1 that is donated.
Fees - see above for how to pay
Entry Fee up to Saturday 13 May 2017  £225.00- 
Entry after 14 May 2017  £250.00

Class 0 up to Saturday 13 May 2017 £200.00

 

 

 

 

 

£
Club Membership £
Charity Donation - suggested minimum £15.00£
Marshals Draw£
Total Money to be sent£
Payment Method and Details
Entrant (if applicable and not driver)
Name
Address
Post Code
Telephone Number
Competition Licence Number
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:

1. 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 risk.

2. In consideration of the acceptance of this entry, I agree that neither any one of or 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  each of the Parties in respect of any loss or damage whatsoever and howsoever arising from my participation in the Event.   

3. 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.

4. 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.

5. 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 or Guardian ‘I confirm that I have acquainted myself 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.’

6. I have read and fully understand 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 websites 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 the minor (UKAD Code Art 5.6.2) I hereby confirm that I give such consent to the minor concerned to be so tested.

7. I hereby agree to abide by the MSA Child Protection Policy and Guidelines.

Note: Where the Parent or Guardian is not present at the event there must be a representative who must produce a written and signed authorisation to so act from the Parent or Guardian as appropriate.

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