Harold Palin Memorial Stages October 7th 2018 Internet Entry Form

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

Welcome to the Harold Palin Memorial on line Entries

Entries Close for seeding on Saturday 29th September 2018

If places remain entries will be accepted up to Thursday 4th October 2018 but will not be included in the seeding.

ENTRY SUBMISSIONS WITH MINIMAL INFORMATION WILL NOT BE  ACCEPTED  

Entries are secured only by receipt of a FULLY PAID entry fee, untill this fee is received your entry status is "Acknowledged" -"NOT" Accepted,

 

Secretary: Sandra Hickling

18 Philip Ave,Nuthall,Nottinghamshire, NG16 1EA

Telephone 0115 9384601 (Evenings before 9.30pm Only)

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

 

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 two ways to pay
    1. Please send a cheque  made payable to  Eastwood & District Motor Club  Stages Account to the  Secretary at the address above. 
    2. PLEASE ENSURE YOU PUT THE DRIVERS NAME ON THE REVERSE OF THE CHEQUE FOR REFERENCE PURPOSES
    3. If you have internet or telephone banking, you can arrange for the fees to be paid directly into our account. The details are:

    4.  

      Bank

       

       Yorkshire Bank
      Sort Code  05.0642
      Account No.  48969415
      Account Name Eastwood & District Motor Club ltd Stages account
      Reference Driver's First name and Surname
    5. Within 24 hours of us receiving the payment for your entry you should receive an e-mail confirming your entry from the entries Secretary.
    6. NOTE: WITHOUT PAYMENT YOUR ENTRY WILL NOT BE VALID.
    7.  If you don't receive a response within 3 days of the expected payment date,
    8. or if you have any other questions,please e-mail:.hpmemorialstages@btinternet.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.

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
E-Mail Address
Club
Date of Birth
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
E-Mail Address
Club
Date of Birth
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
Forced Induction
Four Wheel Drive
Class
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 Roadrunner Phoenix Awards ANEMMC Stage Rally Championship (supported by Pantry Catering & Slicks Tyres)
Crew Members Registered
EMAMC Single Venue Rally Championship
Crew Members Registered
ANCC Stage Rally Championship
Crew Members Registered
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 with out this information YOU WILL NOT BE SEEDED
Event Name and ClubYearpermit typeSurfaceOverall PositionClass position
Seeding - Competitor Opinion
Out of 70 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
£240 		£
Club Membership £6 per crew member

 

 

£
The Alzheimer's Society£
Total Money to be sent£
Payment Method - Input ONLY the following:

Cheque or Bank Transfer,  
Direct bank transfer To EDMC Ltd  

Account sort code 05-0642 a/c no 48969415

Cheques; To EDMC

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.

Reminder Entries submissions with anly minimal information will not be accepted

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 Motor Sports Association and 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. Further, I understand that all persons having any connection with the promotion and/or organisation and/or conduct of the event are insured against loss or injury caused through their negligence.."

I declare that the use of the vehicle hereby entered will be covered by insurance as required by the law, which is valid for such part of the event that shall take place on roads as defined by the law.

I understand that should I, at the time of the event be suffering from any disability whether permanent or temporary which is likely to affect prejudicially my 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.

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