Document Addressing E-Mail address for communication Real Name of this person Whom should we send Finals and Results to? Driver Co-Driver How would you like to receive Finals and Results? E-mail/Website Posted Paper 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 No Yes Four Wheel Drive No Yes Class A - 2WD Up to and including 1400cc B - 2WD Over 1400cc, up to and including 1600cc C - 2WD Over 1600cc, up to and including 2000cc D - 2WD Over 2000cc, up to and including 3000cc E - 2WD over 3000cc and All 4WD F - Non-homologated current/former WRC or one derived from one, plus current/former S2000 cars and all FIA R5 cars H1 - Historic Category 1 H2 - Historic Category 2 H3 - Historic Category 3 H4 - Historic Category 4 Mini 1 - Motorsport UK Historic Category 1, 2 & 3 Mini 2 - Cars Not eligible for Mini 1 with an A series engine complete and original fitment gearbox casing. No larger than 12” wheels. Only original fitment arch extensions are permissible. Mini 3 - Cars Not eligible for Mini 2 with an A series engine block and original fitment gearbox casing. Only original fitment arch extensions are permissible. In Car Camera Request No Yes 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 None Driver Co-Driver Both Driver Championship Registration Number Co-Driver Championship Registration Number Fuchs Classic Mini Challenge Crew Members Registered None Driver Co-Driver Both Driver Championship Registration Number Co-Driver Championship Registration Number Motor-Mall Manx Rally Championship Crew Members Registered None Driver Co-Driver Both Driver Championship Registration Number Co-Driver Championship Registration Number Protyre Motorsport UK Asphalt Rally Championship Crew Members Registered None Driver Co-Driver Both Driver Championship Registration Number Co-Driver Championship Registration Number SD34 MSG Stage Rally Championship Crew Members Registered None Driver Co-Driver Both 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 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) No Yes Participating in Shakedown? No Yes Fees - see above for how to pay Entry Fee £ Club Membership £ 0.00 - None 20.00 - Driver 20.00 - Co-Driver 40.00 - Both Crew Insurance £ 0.00 - Use own insurance 30.00 - Jeff Insurance Donation towards Marshal Pack £ 0.00 - No Thank You 5.00 - £5.00 10.00 - £10.00 Shakedown Participation £ 0.00 - No Shakedown 60.00 - Shakedown Donation to Charity £ Total Money to be sent £ Payment Method and Details Telephone/Online transfer with drivers name as reference Cheque made payable to Manx Auto Sport Limited 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.
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.
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.
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)
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.
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.
I hereby agree to abide by the Motorsport UK Safeguarding Policy and Guidelines and the National Sporting Code of Conduct.
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.
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
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.