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Autumn Leaves 12 Car ~ 16th November 2018

Entry Form

Please enter the event(s) using this form, and then pay by Bank Transfer following the instructions on the next page.
You will appear in the entry list as a pending entry immediately, and as an accepted entry once the Entries Secretary has received your payment and verified your entry is complete.

Held under the General Regulations of The Motor Sports Association (incorporating the provisions of the International Sporting Code of the FIA), these Supplementary Regulations and any written instructions (including bulletins) that the organising club may issue for the event.

Undertakings & Indemnities as required by MSA GR D13.1 to D13.1.5 are included on the Official Signing-On Forms for the event, also by submission of the Entry Form you agree to abide by MSA Regulations and any written instructions issued for the event.

Any competitor who is under 18 MUST declare so on this Entry Form and the relevant Parent/Guardian will then be required to conform to MSA D13.1.1(c).

To allow you to update your entry details later.

Driver

Driver's Parent or Guardian (under 18 only)
No   Yes

Driver - Persons to contact in case of serious accident to Driver

Navigator

Navigator's Parent or Guardian (under 18 only)
No   Yes

Persons to contact in case of serious accident to Navigator

Competition Car

No   Yes
TBA    B    N    E    M    
M - Master - Has come in the top five of a National B status road rally, Navigational rally or Restricted rally as a navigator at any time.
E - Expert - Has won three or more First Overall awards on any 12 car or 20/20 events as a navigator.
Or has been First Novice five or more times on any 12 car or 20/20 events as a navigator since 1st September 2016.
N - Novice - All others.
B - Beginner - Has not competed in more than five rallies as a navigator.

Insurance
Own Insurance  JELF - £17 
Extra due in pounds.
No    Yes If you are unable to comply with the Declaration.
If not using JELF.
If not using JELF.

Fees
£10
Bank Payment  Card (via PayPal)  Cash  Cheque 

Chelmsford MC comply with current data protection legislation. I understand that the information submitted through this form, including names, addresses and contact details, may be published or released to other parties purely for purposes connected with the event.



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 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/dataprotection.

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.

Last Updated: May 23, 2018

Entry System available from Tony Michael