Harlech Stages 2018 Internet Entry Form

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

2018 TOYOTA Harlech Stages

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

This entry will not be considered unless:

1. The form has been completed in all aspects
2. The full entry fee has been paid
3. The Declaration of Indemnity has been acknowledged

Seeded Entries Close - Sunday 30th April 2018, 18:00hrs

Final Closing Date - Thursday May 3rd, 21:00hrs

Contact details:

Entries Secretary:
Lois Jones

Llawenan,

Rhiw,

Pwllheli,

Gwynedd

LL53 8AN

Telephone: 07794772627 (19:00 to 21:00hrs only)
Email: lois_angharad@live.co.uk

Contact details of  Event Secretary:
Lois Jones
Email: lois_angharad@live.co.uk

Welcome to the 2018 TOYOTA Harlech Stages 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 three ways to pay
  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 lois_angharad@live.co.uk
Document Addressing
E-Mail address for communication
Real Name of this person
Whom should we send Finals and Results to?
Driver
Full Name
Address
Post Code
Home Town
Telephone Number (Daytime)
Mobile Number for use prior to and during the event
Competition Licence Number

Telephone Number (Evening)

E-Mail Address
Club
Date of Birth if 18 years or under
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 (Daytime)
Mobile Number for use prior to and during the event
Competition Licence Number

Telephone Number (Evening)

E-Mail Address
Club
Date of Birth if 18 years or under
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

Turbo

Class
Camera Request
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
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
J D Tyres Welsh National Tarmacadam 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 75 entries, where do you think you should be seeded?
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 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 [INSERT VIDEO COMPANY HERE] and [INSERT PHOTO COMPANY HERE] 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.

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
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 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 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 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 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 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 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 Safeguarding 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 MSA Yearbook
Regulations H39, D35.1, G15.1.4 and have also fully familiarised myself with the information on the web sites referred to
(www.ukad.org.uk and www.wada-ama.org) in particular the UK Anti-Doping Rules which have been adopted by the MSA. 
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 (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 this 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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