The Core Driver Training Twyford Rally 2018 Internet Entry Form

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

 Entries Close 19th July 2018 at 09:00 (seeding will be done on 15th July 2018)

Entries Secretary:

Stephen Chamberlain

22 Sherwood way,

Selston,

Nottinghamshire.

NG16 6PZ

Telephone 07484 791732

e-mail: entries@mid-derbyshiremc.co.uk Held under the General Regulations of the Motor Sports Association (incorporating the International Sporting Code of the FISA) and the Supplementary Regulations

Welcome to The Core Driver Training Twyford Stages Rally 2018 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. You can pay by Bank transfer Sort code 40-19-37 Account Number 81492926 Please put the Drivers Name and Car Registration as reference.
    2. You can send a cheque, made payable to 'Mid Derbyshire Motor Club' to the Entries Secretary at the address above.
  4. Within 48 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 entries@mid-derbyshiremc.co.uk

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
Association of Northern Car Clubs Multi Use Stage Rally Championship 2018
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Association of North East Midland Motor Clubs Multi Use Stage Rally Championship 2018
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Association of North Western Car Clubs Stage Rally Championship 2018
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
East Midlands Association of Motor Clubs Multi Use Stage Rally Championship 2018
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 60 entries, where do you think you should be seeded?
Scrutineering
When would you prefer to scrutineer? Saturday 3:00 PM to 6:00 PM
Sunday 6:30 AM to 8:30 AM
Which Event are you Competing in?
Fees
Entry Fee Includes £5 to the Air ambulance £
Club Membership £
Forestry Camping Charge£
Donation to D,L,R, Air Ambulance£
Total Money to be sent£
Payment Method and Details
Entrant (if applicable and not driver)
Name
Address
Post Code
Telephone Number
Nationality
Competition Licence Number
Comments
Anything else you'd like to tell us
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 Ian Maddison of Mad Video and both Kevin Money and Malc Almond for Photography 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.

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, 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.

‘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 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.

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 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 hereby agree to abide by the MSA Child Protection Policy and guidelines and the National Code of Sporting Conduct'.

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