logo

PokerStars Rally 2017 Internet Entry Form

Entries Close for seeding on 23 October 2017 at 23:00hrs or finally close on 30 October 2017 at 20:00hrs

Entries Secretary: Nikki Clayton
66 Farmhill Meadows
Douglas
Isle of Man
IM2 2LW

Telephone 01624 624475 (No calls before 10am or after 8pm) (Please note entries secretary will be on leave until 12 Aug 17)
E-mail: nicolajclayton@icloud.com

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 2017 PokerStars Rally 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. If you have internet or telephone banking, you can arrange for the fees to be paid directly into our account. Payment may be in two instalments, the first being for £100.00 an initial deposit, and dated as entry form. The second to be dated 23rd Octoberl 2017 for the balance of the total fees. If you are entering after 23rd October2017, then full payment is due at time of entry.  The details are:-
      Bank Barclays
      Sort Code 20-26-74
      Account No. 00198587
      Account Name Manx Auto Sport Limited
      Reference Driver's full name.
    2. You can send a cheque, made payable to "Manx Auto Sport Limited" to the Entries Secretary at the address above. Cheque Payment may be in two instalments, the first being for £100.00 an initial deposit, and dated as entry form. The second to be dated 23rd October 2017 for the balance of the total fees. If you are entering after 23rd October 2017, then full payment is due at time of entry.  Please include Drivers Name on the back of the cheque.
  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. 
    Please remember, your entry is NOT acknowledged until we receive minimum payment  of £100 (any paid entries received after your entry will be given a guaranteed place prior to yours and you will lose your place in the queue).
  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 entries@manxautosport.org
  6. 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.
  7. For competitors wishing to take advantage of the travel deal then please take the following steps:
    1. Place your entry for the event using the below form and select entry fee inclusive of travel.
    2. Send entry fee inclusive of travel via cheque or online to Manx Auto Sport using the above details.
    3. Contact the team at Isle of Man Event Services Limited on 01624 664460 or info@iomevents.com, quoting "PokerStars Rally".
    4. If you require additional arrange above what is included in the deal, then please inform the team at Isle of Man Event Services when booking. Any additional costs should be paid direct to Isle of Man Event Services Ltd
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
Competition Licence Number
Competition Licence Issuer
E-Mail Address
Club
Date of Birth
Nationality
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
Competition Licence Issuer
E-Mail Address
Club
Date of Birth
Nationality
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
FIA Homologation Number
Insurers
Name
Address
Recce vehicle
Make
Model
Colour
Registration Number
Contact Name
Contact Number
Service vehicle
Make
Model
Colour
Registration Number
Contact Name
Contact Number
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
ANCC Stage Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
ANWCC Stage Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Motor-Mall Manx Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
SD34 MSG Stage Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Swift Shining Stars Rally Series
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
Seeding - Competitor Opinion
Out of 80 entries, where do you think you should be seeded?
Recce & Scrutineering
Participating in Recce?
Fees - see above for how to pay
Entry Fee £
Club Membership £
Insurance £
Donation to the Marshals Fund£
Total Money to be sent£
Payment Method and Details
Entrant (if applicable and not driver)
Name
Address
Post Code
Telephone Number
Nationality
Competition Licence Number
Competition Licence Issuer
Marshal Details
Name
Telephone Number
Mobile Number
Email Address
Experience
Comments
Anything else you'd like to tell us (Include days you would like to Recce here. If you are a local crew please state which tasks you'd like to help with for the event)

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.

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 is 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.

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 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 (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 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. 

Web Entries System provided by rallies.info