Document Addressing E-Mail address for communication Real Name of this person Whom should we e mail information to? Driver Co-DriverAre a printed set of results required?
E-mail/Website Posted PaperDriver 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 Publicity How Long Rallying? Notable Results Any other information 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 Publicity How Long Rallying? Notable Results Any other information Co-Driver's Parent or Guardian (under 18 only) Name Address (if different) Post Code Telephone Number Relationship Car Details Make Model Colour Registration Number Engine Capacity Year Class N3 - Current and former FIA Group N cars over 1400cc up to and including 2000cc N4 - Current and former FIA Group N cars over 2000cc B10/R2 - Over 1400cc up to and including 1600cc inclding all FIA R2B Cars B11 - Over 1600cc up to and including 2000cc B12 - Over 2000cc two wheel drive, including all FIA R3T cars B13 - Over 2000cc four wheel drive cars that do not qualify for Class NR4 or B14 and FIA R4 cars B14 - Current and former World Rally Cars with a sequential gearbox, plus current and former S2000 and R5 cars and any derivatives therefrom. H1/H2 - All Historic Category 1 cars and Category 2 and 3 cars with single cam engines H2 - Historic Category 2 and Category 3 cars with single cam engines over 1600cc and Category 4 cars up to 1600cc H3 - Historic Category 3 cars with multi cam engines over 1600cc and plus all Category 4a cars and Category 4b cars up to 1600cc. H4 - Historic Category 4b cars over 1600cc which comply with R49.1.5 1400C - - Cars up to 1400cc with:- (a) 8 valve engines (b) Engines with more than 8 valves that retain the standard fuel and inlet manifold systems (c) Engines up to 1000cc not eligible for the BTRDA RF1.0 class(d) Current and former FIA Gp N1 cars. 1400S - All other cars up to and including 1400cc. RF1.4 - BTRDA Rally First cars over 1000cc up to and including 1400cc RF1.6 - BTRDA Rally First cars over 1400cc up to and including 1600cc RF2.0 - BTRDA Rally First cars over 1600cc up to and includingg 2000ccFIA Homologation Number Insurance
If you require cover under the REIS 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 Service vehicle Make Model Colour Registration 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 BTRDA Gold Star Championship Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number Co-Driver Championship Registration Number BTRDA Silver Star Championship Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number Co-Driver Championship Registration Number BTRDA Production Cup Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number Co-Driver Championship Registration Number BTRDA Rallye R2 Cup Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number Co-Driver Championship Registration Number BTRDA 1400 Championship Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number Co-Driver Championship Registration Number BTRDA Rally First Championship Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number Co-Driver Championship Registration Number ST Trophy Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number Co-Driver Championship Registration Number BTRDA Historic Cup Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number Co-Driver Championship Registration Number The 2018 Maxxis Tyres MSA English Championship Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number Co-Driver Championship Registration Number The ANCC Stage Rally Championship 2018 Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number Co-Driver Championship Registration Number The ANWWC Forest Rally Championship 2018 Crew Members Registered None Driver Co-Driver BothDriver 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 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 14:00 - 15:00 15.00 - 16.00 16.00 - 17.00 17.00 - 18.00 18.00 - 19.00 19.00 - 20.00 20.00 - 20.30Fees - see above for how to pay Entry Fee £585.00 - All classes EXCLUDING BTRDA Rally First Championship (RF1.0, RF1.4, RF1.6, RF2.0) 535.00 - BTRDA Rally First Championship (RF1.0, RF1.4, RF1.6, RF2.0) ONLY Club Membership £0.00 - Trackrod Motor Club Ltd - Not required 10.00 - Trackrod Motor Club Ltd (until the end of the year) Insurance £0.00 - Using Own Insurance Cover 18.00 - REIS Insurance Cover Larger service bay plate £0.00 - Larger space service plate - Not required 50.00 - Larger space service plate Parking permit for adjacent car park £0.00 - Permit for parking adjacent to service area - Not required 10.00 - Permit for parking adjacent to service area Guest Pack £0.00 - Guest pack - not required 50.00 - Guest pack Rallitrak £ Support the marshals £7.50 - Support the marshals smiley stickers @ £7.50 each (1) 15.00 - Support the marshals smiley stickers @ £7.50 each (2) 22.50 - Support the marshals smiley stickers @ £7.50 each (3) 0.00 - Not required Total Money to be sent £ Please state payment method 1. Stripe (for card payments). 2. Cheque. 3. Bank Transfer 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 Nationality Competition Licence Number Competition Licence Issuer 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.
No YesWe would also like to be allowed to pass on your Name, Address, Post Code and email addresses to Tom Irvin Photography so that they can contact you with a view to offering you photographs of you on the event. If you are happy to allow us to do this, please say so here.
No Yes
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 the MSA and its associated clubs, the organisers, the track owners or other occupiers, the promotors 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 the 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.
I hereby agree to abide by the MSA Safeguarding Policy and Guidelines and the National Sporting Code of Conduct.
I have read and fully understood the Procedure 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.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 (UKAD code Art 5.6.2) I hereby confirm that I give such consent for the minor concerned to be so tested.