Grooms Garage Mid-Wales Stages 2018 Internet Entry Form

Online Entry System

Held under the General Regulations of the Royal Automobile Club Motor Sports Association Ltd (MSA) (incorporating the International Sporting Code of the FIA) the Supplementary Regulations and any written instructions the Club may issue for the Event.

 Entries Close for seeding on 20th February 2018 at 18:00 hrs

  


 

Please follow the steps below to enter the event:

 

1. Complete all the fields in the form below. The fields with red backgrounds are mandatory. These must be filled in or you will not be able to continue

 

2.  WITHOUT PAYMENT YOUR ENTRY WILL NOT BE ACCEPTED - There are two ways to pay

 

 

Bank  HSBC Bank plc, Newtown, Powys. SY16 2LX
Sort Code  40-34-33
Account No.  61051903
Account Name Newtown & District Automobile Club Ltd
Reference Please use Driver's full name

 

 

3. 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

  

4. Within 24 hours of our receiving the payment for your entry you should receive an e-mail acknowledging your entry and payment from the Entries Secretary.  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 entries@midwalesstages.co.uk

 

IMPORTANT

Please ensure that  ALL parts of the form are completed. If you are unsure of any details when completing your entry form please use TBA. However this information MUST be forwarded to the Entries Secretary via email as soon as possible in order to allow the entry to be processed and BEFORE the close of entries on the 20th February 2018.
If you have any other queries or questions please do not hesitate to contact the Entries Secretary:

 

 Di Brookfield

The Firs, Sarn, NEWTOWN, Powys. SY16 4EW

Telephone  01686 670 216

E-mail:   richardedwardshaulage@outlook.com

 

Document Addressing
E-Mail address for communication
Real Name of this person
Whom should we send Finals and Results to?
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'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'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
Forced Induction
Four Wheel Drive
Class
In Car Camera Request
Insurers
Name
Address
Service Vehicle
Make
Length & width in meters
Registration Number
Contact Name
Contact 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
Pirelli MSA Welsh Stage Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Restruct Ltd & the www.jelfmotorsport.com Welsh Mixed Surface Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Brian Dennis Motorsport Welsh Historic Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
HRCR Rally Masters Historic Stage Rally Challenge
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
ANWCC Forest Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
FMP Rally Challenge
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
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 £
Total Money to be sent£
Payment Method and Details
Entrant (if applicable and not driver)
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.

Remember your entry is subject to receipt of the correct entry fee. An automated acknowledgement is NOT confirmation of entry. Rejected entries and entries held in abeyance will be informed by e-mail to the address(es) given above.

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

I consent to the organising committee using the information I have given for the purpose of displaying relevant details on an entry list to be made available to the public via written and electronic means, and for mailings to promote future editions of the Mid-Wales Stages Rally.  The information provided will be treated in confidence and will be held in compliance with the Data Protection Act 1998.  Crews personal details will be shared with members of the Rally and NADAC Committees and address labels/e-mail addresses provided to the Media Officer and Official Photographers/Media of the event for the purposes of distributing Press Releases and advertising their services.  I understand you cannot verify that the Official Photographers/Media will not share such information with other organisations or individuals.
 
MSA INDEMNITY 

Held under the General Regulations of the Royal Automobile Club Motor Sports Association Ltd (MSA) (incorporating the provisions of the International Sporting Code of the FIA) these Supplementary Regulations and any written instructions the Club may issue for the Event.

I declare that:-

 

Web Entries System provided by rallies.info