EventSignsWoodpecker Stages Rally 2018 Internet Entry Form

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

 

 

Welcome to the EVENTSIGNS Woodpecker Stages Rally On-line Entry System

Normal entries close for seeding on Saturday 18th August.

Late entries accepted until Tuesday 28th August.

Entries Secretary: Roger Allan, Longfield, Upper Wick Lane, Rushwick, Worcester, WR2 5SU

Telephone 01905 424987 (up to 22:00) or e-mail: entries@woodpecker-rally.co.uk.

Regulations and a printable entry form are available on the web site www.woodpecker-rally.co.uk.

The Woodpecker Stages Rally is held under the General Regulations of the Motor Sports Association (incorporating the International Sporting Code of the FISA) and the Supplementary Regulations of the event.

Please note: the Parent or Guardian of competitors under 18 must either attend the event to counter sign their MSA Declaration at Signing On or complete a MSA Parental Consent Authorisation authorising their representative to act on their behalf (H27.1.8).

Please complete the following steps to enter the rally:

  1. Complete all the fields in the entry 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 - internet or telephone banking and cheque in the post
    1. For internet or telephone banking, you can make the payment directly into our account. The details are:-
      Bank Barclays Bank 
      Sort Code  20-98-61
      Account No.  00663778
      Account Name Sixty and Worcs Rally Club Ltd
      Reference Driver's full name

    2. For payment by cheque, please make your cheque(s) payable to Sixty & Worcs Rally Club Ltd  and post to the Entries Secretary at the address above.

      Please write the driver's full name on the back of your cheque(s).

    3. Please indicate the payment method used - BANK TRANSFER or ONE or TWO CHEQUES

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
Driver
Full Name
Address
Post Code
Telephone Number
Mobile Number
Competition Licence Number
Competition Licence Issuer
E-Mail Address
Club
Driver's Parent or Guardian (under 18 only)
Name
Address (if different)
Post Code
Telephone Number
Relationship
Co-Driver
Full Name
Address
Post Code
Telephone Number
Mobile Number
Competition Licence Number
Competition Licence Issuer
E-Mail Address
Club
Co-Driver's Parent or Guardian (under 18 only)
Name
Address (if different)
Post Code
Telephone Number
Relationship
Competing Car
Make
Model
Colour
Registration Number
Engine Capacity
Year (particularly for Historic Competitors)
Forced Induction
Four Wheel Drive
Class
If you are using your own insurance for the rally please provide the name, policy number and address of the insurance company:
Insurer's name & policy number
Address
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
Driver Championship Registration Number
Co-Driver Championship Registration Number
BTRDA Silver Star Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
BTRDA 1400 Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
BTRDA Rally First Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
BTRDA Production Cup
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
BTRDA Historic Cup
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Rallye R2 Cup
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
ST Trophy
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Maxxis Tyres MSA English Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Pirelli MSA Welsh Stage Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Brian Dennis Motorsport Welsh Historic Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Restruct Ltd & 'www.jelfmotorsport.com' Welsh Clubman's Mixed Surface Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
FMP Rally Challenge
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
ANWCC Forest Rally 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 (not necessary for drivers who have competed on BTRDA forest rallies in recent years)
Event Name and ClubYearSurfaceOverall PositionClass position
Fees - see above for how to pay
Entry Fee (see drop down options) £
Sixty & Worcestershire MC Membership £
JELF Insurance or Own - Please Select  £
Auxiliary Support Pack£
Total Money to be sent£
Payment Method and Details
Entrant (if applicable and not driver)
Name
Address
Post Code
Telephone Number
Entrants MSA Licence Number
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 the Woodpecker Stages 2019. 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 e-mail address to Writtle Photographic so that they can send photo proofs of you on the event. If you are happy to allow us to do this, please say so here.

The automated acknowledgement is NOT confirmation of entry.

By clicking on the "Enter the Rally" button below you agree to the following: "I declare that:

1. 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 to take part in the event and I am competent to do so. I acknowledge that I understand the nature and type of competition and the potential risk inherent with motor sport and agree to accept that risk. I understand that motor sport 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. 

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. 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 as defined by the law.

3. 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 MSA which has, following such declaration, issued a licence which permits me to do so. 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)

4. Any application form for a Licence which was signed by a person under the the age of 18 years was countersigned by that person's parent/legal guardian/guarantor, whose full names and addresses have been given.

5. 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 confirm that I have acquainted myself and the minor 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 Guardian who must produce a written and signed authorisation to so act from the Parent/Guardian/Guarantor as appropriate.

6. I hereby agree to abide by the MSA Safeguarding Policy and Guidelines and the National Sporting Code of Conduct.

7. I have read and fully understood the Procedure for Control of Drugs and Alcohol as contained in the MSA Yearbook Regulations H39.

8. I understand that my personal data is being processed solely for the purposes of running this event and will be handled by the organisers in accordance with the MSA data protection policy which can be found at www.msauk.org/data-protection. 

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 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 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 this event.

 

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