Raintite Coated Metals, Curzon Wealth Management Patriot Stages 2019 Internet Entry Form

Welcome to the Raintite Coated Metals, Curzon Wealth Management Patriot Stages 2019 On-line Entry Form.

Entries close for seeding on Thursday 19th September.
Entries finally close on Thursday 26th September at midnight.

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

Welcome to the 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. Our only accepted payment method is to pay by Bank Transfer, account name "Caerwent Rally".
    bank
    Please use DRIVERS SURNAME & CO DRIVERS SURNAME as reference.                                                                                              
  4. Within 72 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 AND YOU WILL DROP TO THE BOTTOM OF THE LIST.
  5. If you do not receive a response within 5 days of the expected payment date, or if you have any other questions, please e-mail saunders.shirley@googlemail.com.

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.

Thank you for your entry!

 
Document Addressing
E-Mail address for communication
Real Name of this person
Whom should we send Finals and Results to?
Driver
Full Name
Address
Contact Phone Number (preferably Mobile)
Competition Licence Number
E-Mail Address
Motor Club
Driver's Parent or Guardian (under 18 only)
Name
Address (if different)
Telephone Number
Relationship
Co-Driver
Full Name
Address
Contact Phone Number (preferably Mobile)
Competition Licence Number
E-Mail Address
Motor Club
Co-Driver's Parent or Guardian (under 18 only)
Name
Address (if different)
Telephone Number
Relationship
Car
Make
Model
Colour
Engine Capacity
Class (see article 8)
Championships
CMSG BP Motor Body Builders & Engineers Stage Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
DL Motorsport Parts Ltd ASWMC Stage Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
AWMMC Mr Tyre Heart of England Stage Rally Championship in association with Steve Blackham Motors
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
WAMC Welsh Historic Rally Championship supported by Brian Dennis Motorsport & www.jelfmotorsport.com
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
FUCHS Lubricants Classic Mini Challenge
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Person to be contacted in case of serious accident to Driver
Name
Telephone Number
Relationship
Will this person be attending the event?
Person to be contacted in case of serious accident to Co-Driver
Name
Telephone Number
Relationship
Will this person be attending the event?
Seeding - Past Performance on Rallies of Driver Only
Event NameYearSurfaceOverall PositionClass Position
Seeding - Competitor Opinion
Out of 100 entries, where do you think you should be seeded?
Scrutineering
When would you prefer to scrutineer? Saturday
Sunday
Fees - see above for how to pay
Entry Fee £
Club Membership £
Total Money to be sent£
Payment Method and Details
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 rallies which we are running, including this event in future years. 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 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 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 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.

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 Motorsport UK.’ As the Parent/Guardian ‘I confirm that I have acquainted myself and the minor with 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.

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

If you are paying for membership of Forresters Car Club, you also acknowledge:

"Forresters Car Club Limited is a registered company in England and Wales (Company number 95481928) and is limited by guarantee. By joining Forresters Car Club, you
automatically become a guarantor of Forresters Car Club Limited whereby in the highly unlikely event of the Company being unable to meet its liabilities as they fall due, you may be asked to contribute a maximum of £1 to assist the Company in paying its liabilities. By submitting your membership application you therefore acknowledge that you will become a guarantor of Forresters Car Club Limited for the period that your membership is valid.
All new members are automatically added to our regular member newsletter. After becoming a member you can opt-out of the newsletter at any time."

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