DG Jones Agri Ltd. Powys Lanes Rally 2018 Internet Entry Form

Welcome to the online entry system for the D.G. Jones Agri Ltd Powys Lanes Rally 2018.

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

Please complete all the fields in the form below. The fields with red backgrounds are mandatory and 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 but send them as soon as you do.

Once you have hit the 'Enter the Event' button at the end you will receive an automated response confirming we have received your entry form.

Entries Close for seeding at 21.00hrs on Sunday 28th October 2018. If vacancies are available in the relevant class then entries will be accepted up to 16.00hrs on Wednesday 31st October 2018.

 

Payment:

Direct payments by online or telephone banking are preferred and are the quickest way for us to process your entry. Please make payments to our HSBC account - Powys Lanes Rally, Sort Code 401514, Account Number 61408224, and give a Reference of Driver & Navigator Name.

Please make cheques payable to 'Powys Lanes Rally', write the name of Driver and Navigator on the back and post to the Entries Secretary at the address below. No Cheque entries will be accepted after 20th October 2018. Post dated cheques are not accepted.  

When we have received payment you should receive an e-mail confirming your entry. If you pay by cheque it might take up to 14 days for it to clear. If you don't receive a response within 3 days of the expected payment date, or if you have any other questions, please contact the Entries Secretary.

PLEASE NOTE - WITHOUT PAYMENT YOUR ENTRY WILL NOT BE ACCEPTED

 

Insurance:

If you wish to use JELF Insurance but are unable to comply with all points of Jelf Insurance Partnership's Declaration, you will be required to complete a Declaration Form (see Supplementary Regulations). A letter of acceptance will be issued and any loadings must be paid for at signing on with cash only.

If you intend to pay for JELF Insurance on the night please put 'ON THE NIGHT' in the Insurers 'Name and Policy No' box and select '0.00 - Own Insurance' in the Fees section.

 

Entries Secretary: 

Emma Lewis 

powysentrysec@epyntmc.co.uk

07939 226442 (No calls after 21:00hrs please)

5 Glandwr Park, Builth Wells, Powys, LD2 3DF

 

Document Addressing
E-Mail address for communication
Real Name of this person
Driver
Full Name
Address
Post Code
Telephone Number
Mobile Number
Competition Licence Number
E-Mail Address
Club
Date of Birth
Driver's Parent or Guardian (under 18 only)
Name
Address (if different)
Post Code
Telephone Number
Relationship
Co-Driver
Full Name
Address
Post Code
Telephone Number
Mobile Number
Competition Licence Number
E-Mail Address
Club
Date of Birth
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
Class
Insurers (If using own insurance)
Name
Address
Championships
WAMC Road Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Association of North-Western Car Clubs Road and Navigation Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Association of South-Western Motor Clubs Navigational Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Welsh Border Car Club Road Rally 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 - Past Performance on Rallies (The best 4 results achieved in the last 5 years)
Event Name and ClubYearTypePlease list by Driver then NavigatorOverall PositionNo of Starters
Fees - see above for how to pay
Entry Fee £
Club Membership £
Insurance £
Total Money to be sent£
Payment Method and Details
Marshal Details
Name
Address
Post Code
Telephone Number
Mobile Number
Email Address
Experience
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 signed-on media representatives 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:

1      I have been given an 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 and competent to take part in the event.  I understand that motorsport is 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.              

2.     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.

3.     The use of the vehicle hereby entered is covered by insurance as required by the law which is valid for such part of this event as shall take place on roads as defined by the law.

4.     I understand that should I at the time of any event in this event be suffering from any disability whether permanent or temporary which is likely to affect prejudicially my normal control of the vehicle, I may not take part unless I have declared such disability to the Royal Automobile Club Motor Sports Association Ltd which has, following such declaration, issued a licence which permits me to do so.

5.     Any application form for a licence which was signed by a person under the age of 18 years was countersigned by that person’s parent/legal guardian/guarantor, whose full names and addresses have been given.

6.     If I am the Parent/Guardian/Guarantor of the driver/co-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/Guarantor I confirm that I have acquainted myself 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.

Note:Where the Parent/Guardian/Guarantor is not present there must be a representative who must produce a written and signed authorisation to so act from the Parent/Guardian/Guarantor as appropriate.

7.     I hereby agree to abide by the MSA Child Protection Policy and Guidelines and the National Sporting Code of Conduct.

8.     I undertake that at the time of the event to which this entry relates I shall have passed or am exempt from an ASN specified medical examination within the specified period. (H10.1.6)

9.      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 familiarised myself with the information on the websites referred to (www.ukad.org.ukand www.wada-ama.org) in particular the UK Anti Doping Rules which have been adopted by the MSA (as amended).  Further, if I am counter-signing as the Parent/Guardian/Guarantor of a minor then in addition to the deemed consent to the testing of that minor (Art 5.6.2) I hereby confirm that I give such consent for the minor concerned to be so tested.

Indemnity: 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 land 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.  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.

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