NHMC Cadwell Stages Junior Rally 2018 Internet Entry Form

Entries Close for seeding on 7th November 2018 at 18:00.

Entries Secretary: Gavin Heseltine
43 Station Road
Gilberdyke
BROUGH
HU15 2ST

Telephone: 01430 440114
e-mail: entries@NHMCCadwellStages.org.uk

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

Welcome to NHMC Cadwell Stages Junior Rally 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 4 ways to pay:
    Scheme A - Full Payment by cheque (before Monday 12th November);
    Scheme B - Two cheques (one cheque for £85, dated as entry, and one cheque for the outstanding balance dated on or before Monday 12th November),
    N.B. All cheques should be made payable to 'North Humberside Motor Club Ltd' and sent to the Entries Secretary at the address above. Please write the driver's first name and surname on the back of the cheque(s).
    Scheme C - Direct  transfer to the 'North Humberside Motor Club' HSBC Bank Account - Sort Code 40-22-13 and a/c number 11386506. Please use the driver's first name and surname as the reference.
    Scheme D - Two direct  transfers to the 'North Humberside Motor Club' HSBC Bank Account - Sort Code 40-22-13 and a/c number 11386506 (one for £85 to be made as soon as possible and one for the outstanding balance to be made before 12 noon on Monday 12th November). Please use the driver's first name and surname as the reference.
  4. Within 72 hours of our receiving the payment for your entry you should receive an e-mail acknowledging your entry from the Entries Secretary. NOTE: WITHOUT PAYMENT YOUR ENTRY WILL NOT BE VALID.
  5. If you don't receive a response within 7 days of the expected payment date, or if you have any other questions, please e-mail: entries@NHMCCadwellStages.org.uk.

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 where you do not know the details.

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
Home Town
Telephone Number
Mobile Number
MSA Competition Licence Number
E-Mail Address
Club
Date of Birth (If under 18)
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
MSA Competition Licence Number
E-Mail Address
Club
Date of Birth (If under 18)
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
Forced Induction or Rotary engine
Four Wheel Drive
Class
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.
Eligibility for Championships and Awards
The Junior 1000 Rally Championship
Crew Members Registered
The Junior 1000 Ecosse Challenge
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 Co-Driver
Name
Address
Post Code
Telephone Number
Relationship
Will this person be attending the event?
Seeding - Past Performance on Rallies
Event Name and ClubYearTypeSurfaceOverall PositionPosition in Class
Seeding - Competitor Opinion
Out of 20 entries, where do you think you should be seeded?
Fees - see above for how to pay
Entry Fee £
Club Membership £
Donation to the Marshals Fund£
Total Money to be sent£
Payment Method and Details: Scheme A (1 cheque), B (2 cheques), C (1 direct transfer) or D (2 direct transfers) - see above
Entrant (if applicable and not driver)
Name
Address
Post Code
Telephone Number
Nationality
MSA Competition Licence Number
Marshal Details - if you know of a marshal who'd like to come and help, please give details here
Name
Address
Post Code
Telephone Number
Mobile Number
Email Address
Experience
Comments
Anything else you'd like to tell us
Privacy and Permissions

We take your privacy seriously and shall 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 should 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 should also like to be allowed to pass on your Name, Address, Post Code and email addresses to Mad Video (the event's official video team) and Kevin Money (the event's official photogrpaher) 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.

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 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.

I understand that motorsport can be dangerous and accidents causing death, injury, disability and property damage can and do happen. I understand  that these risks may give rise to my suffering personal injury or other loss and I acknowledge and accept these risks. In consideration of the acceptance of this entry I agree that neither any one of or any combination of the MSA and its associated clubs, the organisers, the track owners or other occupiers, the promoters and their respective officers, servants, representatives and agents (the “Parties”) shall have any liability for loss or damage which may be sustained or incurred by me as a result of participation in the Event including but not limited to damage to property, economic loss, consequential loss or financial loss howsoever caused. Nothing in this clause is intended to or shall be deemed to exclude or limit liability for death or personal injury. To the fullest extent permitted by law I agree to indemnify and hold harmless each of the Parties in respect of any loss or damage whatsoever and howsoever arising from my participation in this event.

I declare that to the best of my belief the driver(s) possess(es) the standard of competence necessary for an event of the type to which this entry relates and that the vehicle entered is suitable and roadworthy for the event having regard to the course and the speeds which will be reached.

If I am the Parent or Guardian of the driver:
I understand that I shall have the right to be present during any procedure being carried out under the Supplementary Regulations issued for this event and the General Regulations of the MSA. As the Parent/Guardian 'I confirm that I have acquainted myself and the minor with the MSA General Regulations, agree to pay any appropriate charges and fees pursuant to those Regulations (to include any appendices thereto) and hereby agree to be bound by those Regulations and submit myself without reserve to the consequences resulting from those Regulations (and any subsequent alteration thereof). Further, I agree to pay as liquidated damages any fines imposed upon me up to the maxima set out in Part 3, Appendix 1.'

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

I have read and fully understood the Procedure for Control of Drugs and Alcohol as contained in the Competitors’ and Officials’ Yearbook Regulations H39, D35.1, G15.1.4 and have also fully familiarised myself with the information on the web sites referred to (www.ukad.org.uk and www.wada-ama.org) in particular the UK Anti Doping Rules which have been adopted by the MSA. Further, if I am counter-signing as the Parent or Guardian of a minor then in addition to the deemed consent to the testing of that minor (UKAD Code Art 5.6.2) I hereby confirm that I give such consent for the minor concerned to be so tested.

I hereby agree to abide by the MSA Safeguarding Policy and Guidelines and the National Sporting Code of Conduct."

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