Trackrod Historic Cup 2017 (incl Land Rover Chall) Internet Entry Form

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

Entries close for seeding on Saturday 16th September 2016 - 10.00hrs
Final closing date for entries is Tuesday 26th September 2016 - 10.00hrs

Entries Secretary: Nicola Sanderson
Trackrod Rally Yorkshire
37 Poplar Avenue
Wetherby
LS22 7RA

Telephone: +44 (0) 1937 583615

E-Mail: trackrod.rally@gmail.com

Held under the General Regulations of the Motor Sports Association and the Supplementary Regulations

Welcome to the Trackrod Historic Cup Online Entry system. Please follow the steps below to enter the rally.

Complete all the fields in the form below. The fields with red backgrounds are mandatory.
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.
There are then three ways to pay
1. By Paypal
2. You can send a cheque, made payable to 'Trackrod Rally Yorkshire' to the Entries Secretary at the address above.
3. Payment can be made by bank transfer (for example internet banking or telephone banking) to the organiser's bank account. The details are as follows: Bank Barclays Bank Sort Code 20-43-47 Account number 50112895 Account name TRACKROD MOTOR CLUB (RALLY YORKSHIRE). Please quote the driver's first name and surname as the reference.
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 trackrod.rally@gmail.com

Document Addressing

E-Mail address for communication

Real Name of this person

Whom should we e mail information to?

Driver
Co-Driver

Are a printed set of results required?

E-mail/Website
Posted Paper

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 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

Mobile Number

Competition Licence Number

Competition Licence Issuer

E-Mail Address

Club

Date of Birth

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 Details

Make

Model

Colour

Registration Number

Engine Capacity

Year

Class

B2 - Cars up to 1000cc & 1001cc to 1300cc
B3 - 1301cc to 1600cc (excluding twin cam engined cars)
B4 - 1601cc to 2000cc (Including twin cam engined cars but excl Porsche 911's)
B5 - Cars over 2000cc including all Porsche 911's
C2 - Up to 1300cc & 1301cc to 1600cc (excluding twin cam engined cars)
C3 - 1601cc to 2000cc
C5 - Over 2000cc, all and multi valve Twin Cam engined cars
D2 - Up to 1300cc & 1301cc to 1600cc including 2 valve twin cam engined cars)
D3 - 1601cc to 2000cc
D4 - over 2000cc including twin cam multi valve engined cars
D5 - All other twin cam multi valve engined cars
E1 - Cars up to 1600cc
E2 - Cars over 1601cc
F1 - Cars up to 1600cc
F2 - Cars over 1601cc
G1 - Cars up to 1600cc
G2 - Cars over 1600cc
Z1 - For 2wd cars registered before 31 December 1990, not conforming to MSA R49. Cars up to 1600cc.
Z2 - For 2wd cars registered before 31 December 1990, not conforming to MSA R49. Cars over 1600cc
LR1 - British Armed Forces Motoring Association
LR2 - Invited Land Rovers of similar type to BAFMA specification

FIA Homologation Number

Insurance

If you require cover under the REIS Road Traffic Act Insurance Scheme payment must be included with your entry.
If you are arranging your own Road Traffic cover, please provide details below.

Name

Address

Service vehicle

Make

Model

Colour

Registration Number

Additional service vehicle (if purchased additional plate)

Make

Model

Colour

Registration 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

The Mintex British Historic Rally Championship

Crew Members Registered

None
Driver
Co-Driver
Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

The Motoscope Northern Historic Rally Championship

Crew Members Registered

None
Driver
Co-Driver
Both

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 Club	Year	Type	Surface	Overall Position	No of Starters

Scrutineering

What time would you prefer to scrutineer? (TICK ONE ONLY) If no time is marked, ANY free time slot will be allocated

13.01 - 14.00
14.01 - 15.00
15.01 - 16.00
16.01 - 17.00
17.01 - 17.30

Fees - see above for how to pay

Entry Fee

Insurance

Rallitrak

Support the marshals

Additional Service Plate

Guest Pack

Total Money to be sent

Pleas state payment method 1. Paypal. 2. Cheque. 3. Bank Transfer

Entrant (if applicable and not driver) No entry will be credited to an Entrant unless the Licence Number is quoted here. This licence MUST be produced at signing on.

Name

Address

Post Code

Telephone Number

Nationality

Competition Licence Number

Competition Licence Issuer

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:

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 to take part in the event and am competent to do so. I acknowledge that I understand the nature and type of the competition and the potential risk inherent with motorsport 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 promotors 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 the 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.

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/guardian/guarantor. Proof of Guardianship may be required.

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 can 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 of 2017 MSA Yearbook.”

Note: Where the Parent is not present there must be a Guardian who must produce a written and signed authorisation from the Parent/Guardian to act as their representative.

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

Doping Special Note

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.

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