Kick RoD 2018 Internet Entry Form

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

 

 

 

 

Entries Close for seeding on Saturday 1st April 2018 at 8pm

 

Entries Secretary
Matlock Motor Club
Field House
Wheatbridge
CHESTERFIELD
Derbyshire
S40 2AB


Mark Oliver
Tel: 07774 136977
Email: KickRoDentries2018@gmail.com

The entry list may close before 1st April if there is a full entry list and adequate reserves, or may remain open after that date and time, at the discretion of the organisers.
 

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

Please try to provide a marshal for this event. 

 

Welcome to the Kick RoD 2018 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. PREFERRED METHOD :
      If you have internet or telephone banking, you can arrange for the fees to be paid directly into our account. The details are:
      Bank Natwest
      Sort Code 60-40-09
      Account No. 80145590
      Account Name Matlock Motor Club Limited
      Reference Driver's full name
      or
    2. You can send a cheque, made payable to 'Matlock Motor Club Limited' to the Entries Secretary at the address above.
    3. NOTE You cannot pay in cash unless in extaordinary cicumstances and only by prior arrangement with the Entries Secretary.
  4. When we have received the payment for your entry you will receive an email confirming your entry from the Entries Secretary.

    NOTE: WITHOUT PAYMENT YOUR ENTRY WILL NOT BE ACCEPTED
     
  5. If you don't receive a response within 3 days, or if you have any other questions, please contact the Entries Secretary.
  6. All the fields with a red background must contain a response from you or you will not be able to continue. 
    Please put TBA in any red field ONLY for which you do not know the details, and confirm any missing information to the Entries Secretary as soon as possible.  
    You will not be able to edit your entry at a later date, so please provide as much information as possible now to avoid causing additional work for the organisers.
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
Telephone Number
Mobile Number (or main number if no mobile)
Competition Licence Number
E-Mail Address
Club
Driver's Parent or Guardian (under 18 only)
Name
Address (if different)
Post Code
Telephone Number
Relationship
Navigator
Full Name
Address
Post Code
Telephone Number
Mobile Number (or main number if no mobile)
Competition Licence Number
E-Mail Address
Club
Navigator's Parent or Guardian (under 18 only)
Name
Address (if different)
Post Code
Telephone Number
Relationship
Car
Make
Model
Colour
Registration Number
Class
Championships
Association of Northern Car Clubs Road Rally Championship
Crew Members Registered
Association of North West Car Clubs Road Rally Championship
Crew Members Registered
Association of North East Midlands Motor Clubs Road Rally Championship
Crew Members Registered
Association of West Midland Motor Clubs
Crew Members Registered
SD34 Motorsport Road Rally Championship
Crew Members Registered
HRCR Premier Rally Championship
Crew Members Registered
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 Navigator
Name
Address
Post Code
Telephone Number
Relationship
Will this person be attending the event?
Seeding - Past Performance on Rallies

Please add (D)  (N)  or  (C)  after the Event Name to indicate Driver Navigator or Combined Crew result

Event Name and ClubYearTypeOverall PositionNo of Starters
Seeding - Competitor Opinion
Out of 50 entries, where do you think you should be seeded?
Fees - see above for how to pay
Entry Fee £
Club Membership £
Insurance £
Donation to the Derbyshire, Leicestershire and Rutland Air Ambulance£
Buy a cold Marshal a well earned Breakfast£
Total Money to be sent£
Payment Method and Details
Marshal Details:

 

 

 

It is not the organisers policy to insist that entries are subject to providing a Marshal. However, without adequate volunteers we cannot run the event. With that in mind we ask all crews to try and help by nominating a marshal. Please contact Charlie Wheeldon at charles.wheeldon@btinternet.com or 07973567239. Thanks.

Name
Address
Post Code
Telephone Number
Mobile Number
Email Address
Experience
Comments
Anything else you'd like to tell us

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.

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.  I declare that the use of the vehicle hereby entered will be covered by insurance as required by the Law, and that this insurance is valid for such part of this event as shall take place on roads as defined by the Law.  If I am unable to comply with S18 of the Supplementary Regulations, I will complete and return a declaration form to the Entries Secretary at least 14 days before the event. 

I agree that my details may be passed to the official event photographer for contact purposes."

Web Entries System provided by rallies.info