2017 Rally North Wales Internet Entry Form

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

2017 NORTH WALES RALLY SERVICES - RALLY NORTH WALES

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

This entry will not be considered unless:

1. The form has been completed in all aspects
2. The full entry fee has been paid
3. A copy of the entrant's licence has been provided, if necessary
4. The Declaration of Indemnity has been acknowledged
     Very important if the driver is not the entrant

Seeded Entries Close - Friday 24 March 2017, 18:00hrs

Final Closing Date - Friday 31 March 2017, 18:00hrs

Entries Secretary:
Sue Freeman
31A Horsebrook Lane
Brewood
Staffordshire
ST19 9EF

Telephone: +44 (0) 1902 851446 (18:00 to 21:00hrs only)
Email: entry.secretary@rallynorthwales.co.uk

 

Welcome to the 2017 North Wales Rally Services - Rally North Wales 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
  4. 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.
  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 entry.secretary@rallynorthwales.co.uk
  6. The entry fee has been based on the current Forestry Commission road charges.  Should there be any variation in these charges, it may be necessary to levy an additional entry supplement, which will be collected 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
Home Town
Telephone Number (Daytime)
Mobile Number for use prior to and during the event
Competition Licence Number

Telephone Number (Evening)

E-Mail Address
Club
Date of Birth if 18 years or under
Nationality
Driver Publicity
Hobbies
Married?
No of Children
How Long Rallying?
Notable Results
Any other information
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 (Daytime)
Mobile Number for use prior to and during the event
Competition Licence Number

Telephone Number (Evening)

E-Mail Address
Club
Date of Birth if 18 years or under
Nationality
Co-Driver Publicity
Hobbies
Married?
No of Children
How Long Rallying?
Notable Results
Any other information
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

Turbo

Class
Camera Request
Insurers
Name
Address
Service Crew Details
Emergency Contact Name of  Service Crew member for use during the event
Emergency Contact Mobile phone number of Service Crew member for use during the event
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
Mintex MSA British Historic Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Pirelli MSA Welsh Forest Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
HRCR Stage Masters Challenge
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
The www.jelfmotorsport Welsh Clubman's Forest Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Brian Dennis Motorsport Welsh Historic Rally Welsh Historic Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
ASWMC Loose Stage Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
ANWCC Forest Rally Stage Championship
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 Rallies
Event Name and ClubYearTypeSurfaceOverall PositionNo of Starters
Scrutineering
When would you prefer to scrutineer? Between 1600 hours and 1630 hours
Between 1630 hours and 1700 hours
Between 1700 hours and 1730 hours
Between 1730 hours and 1800 hours
Between 1800 hours and 1830 hours
Between 1830 hours and 1900 hours
Between 1900 hours and 1930 hours
Between 1930 hours and 2000 hours
Fees - see above for how to pay
Entry Fee £
Insurance £
WSSCC membership£
Auxiliary Management Pack @ £25 each£
Full Colour Souvenir Programme @ £5 each£
Contribution to Marshals' Fund @ £10 each£
Total Money to be sent£
Payment Method and Details
Entrant (if applicable and not driver)
Name
Address
Post Code
Telephone Number

Mobile Number for use during the event in case of emergency

Competition Licence Number

Team Name

Postal Address Details

Name
Address
Post Code

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.

Declaration of Indemnity

I declare that:

1. I have been given an 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.


2 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.


3. 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 defined by the law.

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 the 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. Any application form for a licence which was signed by a person under the age of 18 years was countersigned by
that person’s parent/legal guardian/guarantor, whose full names and addresses have been given.

6. 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 can 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.

Note: Where the parent/guardian/guarantor is not present there must be a representative who must
produce a written and signed authorisation to so act from the parent/guardian/guarantor as appropriate.

7. I hereby agree to abide by the MSA Child Safeguarding Policy and Guidelines and the National Sporting Code of Conduct.

8. I undertake that at the time of the event to which this entry relates I shall have passed or am exempt from an ASN
specified medical examination within the specified period (H10.1.6).

9. I have read and fully understood the Procedure for Control of Drugs and Alcohol as contained in the MSA 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 (Art 5.6.2) I hereby confirm that I give such consent for the minor concerned to be so tested.

Indemnity:  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 land 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 this 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 this event.

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