Welsh Marches Mini Epynt 2018 Internet Entry Form

Welcome to the Apex Motor Parts Welsh Marches Mini Epynt 2018 On-line Entry Form.

Entries Close for seeding on 23rd May at 12 Noon

Entries Secretary:

Louise Roberts
15 Windmill St
Brill
Buckinghamshire
HP18 9SZ
Mobile 07956 358110
e-mail: louise.wilcox@anloassociates.com

 

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

Welcome to the Welsh Marches Mini Epynt Stages 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.  Payment to made by Credit Transfer via "Online Banking,    
    Bank Barclays
    Sort Code 20-39-64
    Account No 30478881
    Please use DRIVERS SURNAME & CO DRIVERS SURNAME as reference                                                                                                                                                                                                                                           
  4. 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 AND YOU WILL DROP TO THE BOTTOM OF THE LIST.
  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: louise.wilcox@anloassociates.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 at this time.  Please provide any missing information or advise any changes by e-mail as soon as you are aware of them and as far as possible prior to arriving at the event.

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Document Addressing
E-Mail address for communication
Real Name of this person
Driver
Full Name
Address
Post Code
Home Town
Telephone Number
Mobile Number
Competition Licence Number
E-Mail Address
Motor Club
Date of Birth
Driver Publicity
Hobbies
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
Motor Club
Date of Birth
Co-Driver Publicity
Hobbies
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
Eligible for "Best Mixed/Female Crew" Award
Eligible for "Best HMC Crew" Award (see article 17)
Class (see article 6)
Eligible for "Best Epynt Virgin" Award (see article 17)
In Car Camera Request (See article 10.9) Equipment MUST be installed prior to scrutineering.
Insurance (article 12)
Will you be using the REIS Insurance Scheme?
If you have your own Insurance Cover for the Event please provide the following: Insurance company, address, policy number
Championships
2018 King of Epynt Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
2018 RAC Historic Asphalt 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 (see article 7.7) - Past Performance on Rallies of driver only
Event Name and ClubYearTypeSurfaceOverall / Class PositionNo of Starters
Seeding - Competitor Opinion
Out of 80 entries, where do you think you should be seeded?
Fees - see above for how to pay
Entry Fee £
Club Membership £
Insurance £
Donation to the Marshals Fund (£5 per smiley badge)£
Total Money to be sent£
Payment Method and Details
Entrant (if applicable and not driver)
Name
Address
Post Code
Telephone Number
Competition Licence Number
Comments

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.

Any information provided will be stored on a computer retrieval system and will be used for organisational and publicity purposes

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 understand that should I at the time of this event be suffering from any disability whether permenent or 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 decleration, issued a licence which permits me to do so.  

I declare that the use of the vehicle hereby entered will be covered by insurance by the law which is valid for such part of the event as shall take place on roads as defined by the law"

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