Trackrod Historic Challenge 2010 Internet Entry Form

THIS EVENT IS IN TEST MODE

Entries to this event are now closed and this page is for record only

Entries close for seeding on Thursday 9th September 2010 - 09.00hrs
Final closing date for entries is Thursday 16th September 2010 - 09.00hrs

Entries Secretary: Nicola Sanderson
Trackrod Rally Yorkshire
37 Poplar Avenue
Wetherby
LS22 7RA

Telephone: +44 (0) 1937 587508

E-Mail: trackrod.rally@talktalk.net

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 Trackrod Rally Yorkshire 2010 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. By Paypal
    2. You can send a cheque, made payable to 'Trackrod Rally Yorkshire' to the Entries Secretary at the address above. Please include drivers name on back of 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 trackrod.rally@talktalk.net 

 

Document Addressing
E-Mail address for communication
Real Name of this person
Whom should we send information to?

Are a printed set of results required?

Driver
Full Name
Address
Post Code
Telephone Number
Mobile Number
Competition Licence Number
Competition Licence Issuer
E-Mail Address

Town for the Entry List

Nationality

Co-Driver
Full Name
Address
Post Code
Telephone Number
Mobile Number
Competition Licence Number
Competition Licence Issuer
E-Mail Address

Town for Entry List

Nationality

Car Details
Make
Model
Colour
Registration Number
Engine Capacity
Class
FIA Homologation Number
Insurance

If you require cover under the Lockton Road Traffic Act Insurance Scheme payment must be included with your entry.
If you are arranging your own Road Traffic cover, please provide details below.
Name
Address
Assistance Plate Application Form I apply for the plates detailed on this entry form including service plates. I have read and understood Appendix 5 of the regulations. I accept responsibility for the conduct of the users of these plates throughout the event.
Make
Model
Colour
Registration Number

Type of  Plate applied for

Assistance vehicle  No 2

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
The HRCR Historic Stage Rally Challenge 2010 incorporating the Mini Cup supporte by TR Enterprises
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
Scrutineering
What time would you prefer to scrutineer? (TICK ONE ONLY) If no time is marked, ANY free time slot will be allocated



13.00 - 14.00
14.01 - 15.00
15.01 - 16.00
16.01 - 17.00
17.01 - 18.00
18.01 - 19.00
19.01 - 20.00
Fees - see above for how to pay
Entry Fee £
Insurance £
Rallitrak Safety Radio System (Obligatory)£
Auxiliary Plate£
Guest Pack£
Motorhome Plate£
Support Plate£
Support the marshals "smiley" stickers @ £7.50 each£
Total Money to be sent£
Payment Method and Details
Entrant (if applicable and not driver) No entry will be credited to an Entrant unless the Licence Number is quoted here.  This licence MUST be produced at signing on.
Name
Address
Post Code
Telephone Number
Competition Licence Number
Competition Licence Issuer

The details on this form will be held on computer in order to be used for the administration of this event. They will also be used to send you information about future events organised by this club, unless you untick this box to indicate you do not wish to receive information on further events.
The details on this form may also be passed on to other motorsport organisations, unless you untick this box to indicate you do not wish these details passed on.

Declaration of Indemnity

 

I declare that:

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
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.


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 will be covered by insurance as required by the law which is valid for such part
of this event as shall take place on the roads defined by the law.

4. 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 the ASN who have, 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/guardian/guarantor, whose names and addresses have been given.

6. 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
the MSA. As the Parent/Guarantor “I can 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 MSA General Regulations Part 3, Appendix 3”

Note: Where the parent/guardian/guarantor of the driver 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.

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.

 

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