Rali Bryniau Clwyd 2018 Internet Entry Form

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

Welcome to the CMA Chester Ltd, Keith Billows Memorial Rali Bryniau Clwyd Online Entry System. Please read the details below and follow instructions on how to enter the event. We look forward to receiving  your entry and if you have any questions please  contact a member of the organising team

Entries Close for seeding on 11th November at 18.00hrs

Nia Jones

Gorsedd farm

Gorsedd

Holywell

Flintshire

CH8 8QZ

Email: ninswyn@outlook.com
Home: 01352 717980
Mobile: 07777659186
Between 7pm and 9pm

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

Welcome to  Rali Bryniau Clwyd Online Entry system. Please follow the steps below to enter the rally.

  1. Complete ALLthe 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. The details are:-
      Bank HSBC
      Sort Code 40-17-14
      Account No. 52036479
      Account Name Broughton - Bretton Motor Club
      Reference Driver's full name.
    2. Or you can send a cheque, made payable to 'Broughton - Bretton Motor Club Ltd' to the Entries Secretary at the address above 
  4. Within 48 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 after 7 days of submitting an entry we haven't recived your payment we will contact you as a reminder
  5. 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 ninswyn@outlook.com

    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.

    PLEASE COMPLETE AS MUCH OF THE ENTRY FORM AS POSSIBLE TO SAVE TIME ON THE NIGHT - IF WE RECEIVE AN ENTRY WITH A LACK OF DETAILS WE WILL CONTACT YOU FOR THE REST AND YOUR ENTRY MAY NOT BE DEEMED TO BE ACCEPTED UNTIL WE HAVE RECEIVED THOSE DETAILS
Document Addressing
E-Mail address for communication
Real Name of this person
Whom should we send Finals and Results to?
Event Finals and Results will be available to download and will also be emailed to the address provided. If you would like a paper set posted to yourself please let us know here
Driver
Full Name
Address
Post Code
Home Town
Telephone Number
Mobile Number
Competition Licence Number
E-Mail Address
Club
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
E-Mail Address
Club
Date of Birth
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
Year
Class
Insurance - Please Complete in Full
Insurers Name & Your Policy Number
If you are using the Jelf On Event Insurance Scheme please state Jelf otherwise please complete in full
Insurance Company's Address
Championships
ANWCC - Road Rally 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 ClubYearTypeOverall PositionNo of Starters
Fees - see above for how to pay
£80 which includes 2 x breakfasts £
Club Membership £
If using JELF £25 before any loadings £
Total Money to be sent£
Payment Method and Details
Marshal Details
Name
Address
Post Code
Telephone Number
Mobile Number
Email Address
Experience
Important Details - Please Read
Please tell us your marshals preferred control type ( Time or Passage Control) and when during the event ( Early, Middle, End) they would like to marshal. Also if your marshal is able to do two controls please let us know.  We will do our best to match your requirements, but cannot guarentee your marshal will get what they asked for. 
NB: You will not be allowed to start unless your marshal has signed on and no refund will be given



***********VERY IMPORTANT NOTICE***************
ANY ENTRY MADE BY A PERSONS UNDER THE AGE OF 18 YEARS, WHETHER AS A DRIVER OR NAVIGATOR MUST BE MADE WITH A COMPLETE MSA PARENTAL CONSENT AUTHORISATION FORM. THIS FORM MUST BE FILLED IN BY A PARENT OR GUARDIAN. THIS CAN BE OBTAINED VIA THIS LINK -----MSA PARENTAL CONSENT FORM----
THIS FORM MUST BE RETURN TO THE ENTRIES SECRETARY BEFORE THE START OF THE EVENT
Privacy and Permissions

We take your privacy seriously and will only use your personal information to administer your entry, including providing a public Entry List and sending you emails in connection with your entry. Some of your information will be passed on to the organisation providing results for the event.

We would also like to be allowed to contact you in the future to tell you about other events which we are running, including this event in future years. If you are happy to allow us to do this, please say so here.

We would also like to be allowed to pass on your Name, Address, Post Code and email addresses to [INSERT VIDEO COMPANY HERE] and [INSERT PHOTO COMPANY HERE] so that they can contact you with a view to offering you videos and photos of you on the event. If you are happy to allow us to do this, please say so here.

By clicking on the "Enter the Rally" button below you agree to the following: "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 the 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.."

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