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The MGJ Engineering Brands Hatch Winter Stages ~ 20th January 2018

Entry Form

Please enter the rally using this form, and then pay by BACS, cheque or Paypal 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) and the Supplementary Regulations for this 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.
Entries cannot be accepted from non-MSA licence holders.

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).

Please complete all required information.


Contact - Details of person making this entry
To allow you to update your entry details later.

Driver
JELF AEMC/ASEMC   ACSMC   MSN   Michelin Cup   Protyre Challenge   Hockly Swift Cup  
Championships:
JELF - The Jelf Motorsport.com AEMC/ASEMC Stage Rally Championship
ACSMC - The Hamilton Classics ACSMC Stage Rally Championship
MSN - The Motorsport News Circuit Rally Championship in association with MSVR
MC - Michelin Cup
PC - Protyre Challenge
HC - Hockly Swift Cup

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

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

Co-driver
JELF AEMC/ASEMC   ACSMC   MSN   Michelin Cup   Protyre Challenge   Hockly Swift Cup  
Championships:
JELF - The Jelf Motorsport.com AEMC/ASEMC Stage Rally Championship
ACSMC - The Hamilton Classics ACSMC Stage Rally Championship
MSN - The Motorsport News Circuit Rally Championship in association with MSVR
MC - Michelin Cup
PC - Protyre Challenge
HC - Hockly Swift Cup

Co-driver's Parent or Guardian (under 18 only)
No   Yes

Persons to contact in case of serious accident to Co-driver

Person who is at the event to contact (Service Crew Member Etc)

Car

No   Yes
No   Yes
TBA 
Class A - Up to 1400cc
Class B - 1401cc to 1600cc
Class C - 1601cc to 2000cc
Class D - Over 2000cc
Class E - All 4 Wheel Drive
TBA   Friday 19 Jan 2017 – 16:00 to 19:00    Saturday 20 Jan 2017 – 06:00 to 08:00

Past Performance on Rallies - Please ensure you complete this section

Event Name & Club      Year       Type       Surface       Overall Position       Starters.
Where would you expect to be seeded out of 90?

Sponsor

Entrant (If Applicable)

Event Programme - Text and photo to be included in official event programme
0 words. Words left: 35
JPG, PNG or GIF.

Media Information Form - Driver

Media Information Form - Co-driver

Chelmsford Motor Club Membership
If you require Chelmsford Motor Club Membership – Tick below and then follow the link after you fill in this form to complete the CMC Membership Online Form
No   Yes
No   Yes

Fees
£295
BACS  PayPal  Cash  Cheque 



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

I understand that motorsport 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. 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.

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.

If I am the Parent or Guardian 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 '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.'

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 have read and fully understood the Procedure for Control of Drugs and Alcohol as contained in the Competitors’ and Officials’ 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 (UKAD Code Art 5.6.2) I hereby confirm that I give such consent for the minor concerned to be so tested.

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

Entry System available from Tony Michael