Roberts Garages Jersey Rally 2018 Internet Entry Form

 

Jersey Rally

Entries Secretary:

Angie Renouf
61 Marett Court
Marett Road
St Helier
JE2 4PZ
Telephone 01534 862375

e-mail: jerseyrally@jerseymotorsport.com

Date: 12th & 13th October 2018

Permit Number:104142

This Event is held Under the General Regulations of the MSA Motor Sports Association (incorporating the provisions of the International Sporting Code of the FIA) the Standing Competition Rules and Supplementary Regulations of the Club. 

Welcome to Jersey Motorcycle and Light Car 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

1) If you would like to pay via credit or debit card, you will get a link after submitting your entry. Please be aware that you will be charged a 4% surcharge to pay via PayPal, this is to cover the PayPal fees.

2) You can send a cheque, made payable to "Jersey Motorcycle and Light Car Club" to the Entries Secretary at the address above. Please write the drivers name on the back of the cheque.

 

Within 3 days of us receiving the payment for your entry you should receive an e-mail confirming reciept of 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 Information
E-Mail address for communication
Contact Name
Electronic Entry (Office Use Only!)
Driver
Name
Address
Post Code
Telephone Number
Mobile Number
MSA Licence Number
E-Mail Address
Driving Licence Number
Date of Birth
Have you competed in a stage rally before?
Driver Media Information
Occupation
Sponsors
Scariest moment in a car
How Long Rallying?
Best Result to Date
Any other information
or Items of Interest relating to the car
Driver's Parent or Guardian (under 18 only)
NOTE: Parent or Guardian MUST attend signing on.
Full Name
Mobile Number
Telephone Number
Relationship
Co-Driver
Name
Address
Post Code
Telephone Number
Mobile Number
MSA Licence Number
E-Mail Address
Driving Licence Number
Date of Birth
Have you competed in a stage rally before?
Co-Driver Media Information
Occupation
How Long Rallying?
Any other information
Co-Driver's Parent or Guardian (under 18 only)
NOTE: Parent or Guardian MUST attend signing on.
Name
Mobile Number
Telephone Number
Relationship
Competing Car
Make
Model
Colour
Registration Number
Engine Capacity (cc)
Class
Road Insurers
Insurers
Insurance Agent
Service Vehicle
 Make
 Model
 Registration Number
Person to be contacted in case of serious accident to Driver
Name
Telephone Number
Relationship
Person to be contacted in case of serious accident to Co-Driver
Name
Telephone Number
Relationship
Seeding - Performance on Rallies in the last 2 years
Event Name and ClubYearStatusSurfaceOverall Position

Class Position

Seeding - Competitor Opinion
Out of 90 entries, where do you think you should be seeded?
Fees - see above for how to pay
Entry Fee £
JELF Insurance (Road Section) or Own - Please Select appropriate £
Jersey Motorcycle & Light Car Club Membership - Driver (Overseas ONLY)£
Jersey Motorcycle & Light Car Club Membership - Co-Driver (Overseas ONLY)£
Total Money to be sent£
Payment Method and Details
Entrant (if applicable and not driver)
Name
Entrants MSA Licence Number
Tourism Information (This is important in order for the event to maintain support from the local authorities)
Number of hotel bednights used by Driver and Navigator (e.g. 2 people for 7 nights = 14 bednights)
Number of hotel bednights used by the service crew
Number of hotel bednights used by friends an family
Privacy and Permissions

We take your privacy seriously and will only use your personal information to administer your entry, including providing a public Entry / Results 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.

 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.

“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.

I declare the statements given in the entry form are correct as verified by me.

 

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