Scammonden August 12th Hill Climb 2017 Internet Entry Form

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

 Welcome to PENDLE DISTRICT MOTOR Club Online Entry system. Please follow the steps below to enter the event.

Complete all the fields in the form below.

The fields with red backgrounds are mandatory.

Once you have hit the "Enter Event" button at the end you will receive an automated response confirming we have received your entry form.

There are TWO ways to pay :- one cheque,sent to the entries secretary or 

BACS transfer direct to Pendle districts Club account the entry fee is £75


SORT CODE :- 40-09-11 ACCOUNT NUMBER :- 81113011

Please put the drivers name in the reference field,to enable us to identify who has paid.

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 5 days of the expected payment date, or if you have any other questions, please e-mail the entries secretary at the address above.


Contact Infromation
E-Mail address for communication
Contact Name
Electronic Entry (Office Use Only!)

Full Name
Post Code
Telephone Number
Mobile Number
MSA Licence Number
E-Mail Address
MSA Affiliated Club
(of which I am a member)
Date of Birth (if under 20 years of age)
Shared or Double Entries (You will still need to submit 2 entries)
Is this entry part of a shared entry?
Enter the name of the other competitor using this vehicle
Is this entry part of a double entry?
Driver's Parent or Guardian (under 20 only)
Address (if different)
Post Code
Telephone Number
Make & Model
Engine Capacity
Forced Induction
Rotary Engine
Association of North Western car Cubs,Sprint & Hillclimb Championship
Crew Members Registered
The Cross Border speed Championship
Crew Members Registered
Liverpool Moor Club speed Championship
Crew Members Registered
Northern speed championship
Crew Members Registered
SD.34.MSG.Sprint & Hillclimb Championship
Crew Members Registered
Person to be contacted in case of serious accident to Driver
Telephone Number
Fees - see above for how to pay
Entry Fee £
Club Membership £
Total Money to be sent£
Payment Method
Marshal Details
I would like to supply a marshal

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. 

Entry Declaration:

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 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.

A)     In the case of races or speed events “I declare that to the best of my belief the driver(s) possess(es) the standard of competence necessary for the event of the type to which this entry relates and that the vehicle entered is suitable and roadworthy for the event having regrd for the course and the speed which will be reached.”
B)     In the event of any race taking place wholly or partly on publicly adopted roads “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 road as defined by the law”.

I understand that should I at the time of this event be suffering from any disability whether permanent of 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.


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