Entry Form

Held under the General Regulations of the RAC MSA Ltd. (inc. the provisions of the International Sporting Code of the F.I.A) and the Supplementary Regulations.

ENTRANT

No entry will be credited to a trade entrant unless a copy of the licence is sent with this entry form & produced at signing on.


DRIVER

Person to be informed in an emergency

 

CO-DRIVER

Person to be informed in an emergency

*Acceptance of entry will be notified by email only.

CORRESPONDENCE

Send correspondence, including finals by email only


CAR


CLASS ENTERED

  hard copy of the road book to be picked up at documentation


ON-EVENT EMERGENCY MOBILE PHONE NUMBERS


ENTRY FEE

£195

Note: Entries are only accepted once we receive full payment. Therefore paypal on-line will ensure we accept your application quicker.


EVENT CHAMPIONSHIPS

  Event Registration Number
No     Yes J D Tyres Welsh National Tarmacadam Championship 2016
No     Yes The Brian Dennis Motorsport Welsh Historic Rally Championship 2016
No     Yes FMP Rally Challange 2016

SEEDING INFO

Last 3 results for rallies contested as driver

Event Date Event Status Overall Position Class Position

DECLARATION OF INDEMNITY

I declare that:

1) I have been given an 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.
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.
3) The use of the vehicle hereby entered is 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.
4) 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 ASN which has, following such declaration, issued a licence which permits me to do so.
5) Any application form for a Licence which was signed by a person under the age of 18 years was countersigned by that person’s parent/legal guardian/guarantor, whose full names and addresses have been given.
6) 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 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 representative who must produce a written and signed authorisation to so act from the Parent/Guardian/Guarantor as appropriate.
7) I hereby agree to abide by the MSA Child Safeguarding Policy and Guidelines and the National Sporting Code of Conduct.
8) 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)
9) I have read and fully understood the Procedure for Control of Drugs and Alcohol as contained in the MSA 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 (Art 5.6.2) I hereby confirm that I give such consent for the minor concerned to be so tested.

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 land 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 this 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 this event.

State your age if under 18
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.

Entrants Signature: Age if under 18: Date:
Drivers Signature: Age if under 18: Date:
Co-Drivers Signature: Age if under 18: Date:

 

Important note if you are under 18 years of age:
If an Entrant/Driver/Co-Driver is under 18 years of age, this form must be countersigned by his/her parent/guardian/guarantor, whose name, address, relationship to the entrant must be given. Also under revised regulations, effective 1st January 2005 it will be necessary for the parent/guardian/guarantor or representative to be present at the meeting and a separate indemnification must be signed. If you are under 18 years of age, then please contact the organisers prior to submitting your entry.

Name: Relationship:
Address: Signature:
Date :  
Next of kin for Driver: Tel:
Next of kin for Co-Driver: Tel:

This entry form must be completed in every respect, including signing the indemnification