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Nicky Grist Stages 2018 Internet Entry Form

Entries Secretary: Bob Cross
58 St Johns Road,
Pelsall, Walsall,
West Midlands
WS3 4HA.


Home: 01922 682658

Mobile: 07930 856052
e-mail: entries@nickygriststages.co.uk

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

Welcome to the Nicky Grist Stages 2018 On-line 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 three ways to pay
    1. The easiest and cheapest way to pay is on-line by bank transfer. If you have internet or telephone banking, you can arrange for the fees to be paid directly into our account. You need to pay £100 now, with the balance payable no later than the 26th June. The details are:-
      Bank Santander
      Sort Code 09-01-54
      Account No. 23754009
      Account Name Quinton Motor Club Ltd
      Reference Driver's full name.
    2. If you would like to pay via credit or debit card, you will get a link at this point to take you to Paypal's website, where you can pay for your entry by card. Note that we do not see your card details at all, this is all handled for us by Paypal.
    3. You can send a cheque, or 2 cheques if paying in instalments, made payable to 'Quinton Motor Club Ltd' to the Entries Secretary at the address above. One should be for £100 which will be banked on receipt, the second for the balance, which will be banked on the 26th June.
  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.
  5. 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@nickygriststages.co.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 which you do not know the details for.

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.

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 (Important for Media)
Telephone Number
Mobile Number
Competition Licence Number
Competition Licence Issuer (if not MSA)
E-Mail Address
Club
Date of Birth
Nationality (if not British)
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 (Important for Media)
Telephone Number
Mobile Number
Competition Licence Number
Competition Licence Issuer (if not MSA)
E-Mail Address
Club
Date of Birth
Nationality (if not British)
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 / Rotary engine
Four Wheel Drive
Class
In Car Camera Request?
FIA Homologated ? Yes / No
Insurers details if NOT using Jelf Scheme
Insurer & Policy No.
Address.
Auxiliary Service Vehicle
Make
Model
Colour
Registration Number
Contact Name
Contact Number
Service Car
Make
Model
Colour
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
BTRDA® Gold Star Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
BTRDA® Silver Star Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
BTRDA® 1400 Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
BTRDA® Production Cup
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
BTRDA® Historic Cup
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
BTRDA® RALLY FIRST Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
BTRDA® Rallye R2 Cup
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Fiesta ST Trophy
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
MAXXIS MSA English Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Pirelli MSA Welsh Forest Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
ANWCC Forest Stage Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
FMP Rally Challenge 2018
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Shining Stars Rally Series
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 ClubYearTypeSurfaceOverall PositionClass Position
Scrutineering
When would you prefer to scrutineer? Friday 3pm
Friday 4pm
Friday 5pm
Friday 6pm
Friday 7pm
Saturday 7am (Only by prior agreement)
Fees - see above for how to pay
Entry Fee £
Club Membership £
Insurance £
Colour maps (3 maximum per car)£
If NOT allowing event sticker in camera view£
Extra Service Plates (2 maximum per car, must be ordered in advance SR16)£
Camping at Showground£
Guest Passes (3 Maximum per car)£
Total Money to be sent£
How will you pay? (Bank Transfer / PayPal / Cheque)
Entrant (if applicable and not driver)
Name
Address
Post Code
Telephone Number
Nationality
Competition Licence Number
Competition Licence Issuer
Comments
Comments: NOTE: You will be asked to complete a brief questionnaire for the Media Pack / Motorsport News, etc. when your entry is accepted.
Privacy and Permissions

We take your privacy seriously and will 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 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.

We would also like to be allowed to pass on your Name, Address, Post Code and email addresses to [INSERT VIDEO COMPANY HERE] and [INSERT PHOTO COMPANY HERE] 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.

If you wish to pay by bank tranfer (online banking) payments can be made to QMC, Sort Code 09-01-54 account no 23754009. Please enter your entry receipt no and driver surname in the 'Reference' field.

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.

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.."

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