Corinium Stages Rally 2019 Internet Entry Form

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

Entries Close for seeding on Saturday 27th April 2019 23.59hrs.

Please note the Entry Fee is £230

Entries Secretary: Richard Cooper

Telephone 01666 823680
E-mail: corinium.stages@gmail.com

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

Welcome to Corinium Stages Rally 2019 Online Entry system. Please follow the steps below to enter the rally.

  1. Complete at least the RED MANDATORY fields in the form below and as much other information as possible.  Please submit any corrections or missing information to corinium.stages@gmail.com as soon as possible.
  2. Once you have hit the "Enter the Event" button at the end you will be directed to the payment screen displaying the payment options.  You will also receive a confirmation email.
  3. If paying by BACS the Cirencester Car Club Bank Account Number is: Sort code 30-91-99, Account Number 32300460.   Please use Drivers initials and surname as reference.
  4. If paying by Paypal or Card please click the "Pay Now" button and choose to pay by Paypal or Credit Card, then follow normal steps to complete payment. The Paypal payee is corinium.stages@gmail.com  This year there is NO surcharge for using Paypal.
  5. If paying by cheque please make it out to 'Cirencester Car Club' and send it to: Corinium Stages Rally, Entries Secretary, The Nook, Mill Lane, Malmesbury, Wilts. SN16 0HH. (Please note if you are paying by cheque your entry will not be ackowledged until it is received)
  6. If paying by cash please call the Entry Secretary on 01666 823680 between 18:00-21:00 daily to arrange delivery by hand.
  7. WITHOUT PAYMENT YOUR ENTRY WILL NOT BE VALID.
  8. Expect a response to online entries within 3 days and within 7 days if sent by post.  If you have any queries please e-mail corinium.stages@gmail.com or call 01666 823680 between 18:00-21:00 daily. 

Competitors under the age of 18 will require the signature of their parent or guardian as Guarantor. A Guarantor is expected to attend the event and sign-on as an entrant. If they are unable to be present a representative can attend but must produce the Guarantor's written and signed authorisation to act on their behalf.

The fields with a red background are mandatory and 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.

All the data entered on this page will be stored on a computer for the purposes of administering the entries for the Corinium Stages Rally 2018, and will not be passed to any third parties.

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
FULL Address please

VERY IMPORTANT

Post Code
Home telephone Number
Mobile Number
Competition Licence Number
E-Mail Address
Club
Date of Birth (if under 18).
Driver's Parent or Guardian (under 18 only)
Name
Address (if different)
Post Code
Primary Telephone Number
Relationship
Co-Driver
Full Name
FULL Address please

VERY IMPORTANT

Post Code
Home Telephone Number
Mobile Number
Competition Licence Number
E-Mail Address
Club -
Date of Birth (if under 18).
Co-Driver's Parent or Guardian (under 18 only)
Name
Address (if different)
Post Code
Primary Telephone Number
Relationship
Car
Make
Model
Colour
Registration Number
Engine Capacity
Year
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
Cotswold Motor Sport Group
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
2019 DL Motorsports Parts ASWMC Stage Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
2019 Hamilton Classic ACSMC Rally Campionship
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 If no seeding information is given you WILL be seeded at the back
Event Name and ClubYearTypeSurfaceOverall PositionClass Position
Seeding - Competitor Opinion
Out of 75 entries, where do you think you should be seeded?
Fees - Payable by BACS, Paypal/Card, Cheque or Cash.  Details at top of form.
Entry Fee £
Club Membership £
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
Competition Licence Issuer
Comments

Extra comments you feel might be relevant for seeding or about your entry

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 TBA and TBA 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 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'.

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