Chris Kelly Memorial Rally 2019 Internet Entry Form

Entries Close for seeding on 28 April 2019 at 12:00hrs

Entries Secretary
Manx Auto Sport
PO Box 85
DOUGLAS
Isle of Man
IM99 1GQ


E-Mail: entries.manxautosport@gmail.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 2019 Chris Kelly Memorial Rally 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 then two ways to pay ??
    1. If you have internet or telephone banking, you can arrange for the fees to be paid directly into our account. Full payment is due at time of entry.  The details are:-
      Bank Barclays
      Sort Code 20-26-74
      Account No. 00198587
      Account Name Manx Auto Sport Limited
      Reference Driver's full name.
    2. You can send a cheque, made payable to "Manx Auto Sport Limited" to the Entries Secretary at the address above.  Please include Drivers Name on the back of the cheque.
  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.manxautosport@gmail.com
  6. 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.
  7. For competitors wishing to take advantage of the travel deal then please take the following steps:
    1. Place your entry for the event using the below form and select entry fee inclusive of travel.
    2. Send entry fee inclusive of travel via cheque or online to Manx Auto Sport using the above details.
    3. Contact the team at Isle of Man Event Services Limited on +44 (0) 1624 664460 or info@iomevents.com, quoting "Manx National Rally".
    4. If you require additional arrange above what is included in the deal, then please inform the team at Isle of Man Event Services when booking. Any additional costs should be paid direct to Isle of Man Event Services Ltd
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
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
FIA Homologation Number
Insurers
Name
Address
Recce vehicle
Make
Model
Colour
Registration Number
Contact Name
Contact Number
Service vehicle
Make
Model
Colour
Registration Number
Contact Name
Contact Number
Management vehicle
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
ANWCC Stage Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Fuchs Classic Mini Challenge
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Motor-Mall Manx Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Protyre MSA Asphalt Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
SD34 MSG Stage 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
Event Name and ClubYearTypeSurfaceOverall PositionNo of Starters
Seeding - Competitor Opinion
Out of 130 entries, where do you think you should be seeded?
Recce & Scrutineering
When would you prefer to scrutineer? Thursday 9 May 2019
Friday 10 May 2019
Participating in Recce? (Only TWO days out of five are allowed)
Participating in Shakedown?
Fees - see above for how to pay
Entry Fee £
Club Membership £
Insurance £
Donation towards Marshal Pack£
Shakedown Participation£
Donation to Charity£
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
Marshal Details
Name
Mobile Number
Email Address
Experience
Comments
Anything else you'd like to tell us (Include days you would like to Recce here, along with name of people requiring membership)
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 Special Stage 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.

Declaration of Indemnity

 

I declare that:

  1. I have been given the opportunity to read the General Regulations of Motorsport UK 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 competition and the potential risk inherent with motor sport and agree to accept that risk. I understand that motor sport 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.

  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. The use of the vehicle hereby entered will be 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.

  3. 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 the vehicle, I may not take part unless I have declared such disability to Motorsport UK which has, following such declaration, issued a licence which permits me to do so. 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)

  4. 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.

  5. If I am the Parent/Guardian/Guarantor 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

    Motorsport UK. As the Parent/Guardian/Guarantor I confirm that I have acquainted myself and the minor with the Motorsport UK 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 Guardian who must produce a written and signed authorisation to so act from the Parent/Guardian/Guarantor as appropriate.

  6. I hereby agree to abide by the Motorsport UK Safeguarding Policy and Guidelines and the National Sporting Code of Conduct.

  7. I have read and fully understood the regulations 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.motorsportuk.org, www.ukad.org.uk and www.wada-ama.org) in particular the UK Anti Doping Rules which have been adopted by Motorsport UK. 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 (UK Anti-Doping Rule 5.7.2) I hereby confirm that I give such consent for the minor concerned to be so tested.

  8. I understand that my personal data is being processed solely for the purposes of running this event and will be handled by the organisers in accordance with Motorsport UK data protection policy which can be found at

    www.motorsportuk.org/data-protection.
    Indemnity: In consideration of the acceptance of this entry I agree that neither any one of or any combination of Motorsport UK 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.

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