"held under the international sporting code of the fia"
Maiden City Motor Club Ltd Presents Shackleton Charity Festival Classic Rally The competition will be held under the International Sporting Code of the FIA, the General Competition Rules of Motorsport Association (the MSA) and the Regulations as published. INDIVIDUAL ENTRY FORM PLEASE CHECK THAT YOU HAVE DONE THE FOLLOWING 1. ENTERED ALL THE DETAILS OF FIRST DRIVER, SECOND DRIVER, AND ENTRANT. 2. ENTERED THE ADDRESS TO WHICH ALL CORRESPONDENCE SHOULD BE SENT. 3. ENTERED THE DETAILS OF THE CAR. 4. PLEASE INDICATE TO WHOM A REFUND SHOULD BE MADE. 5. ENTER SEEDING ORDER INFORMATION. 6. PLEASE GIVE NAME AND ADDRESS OF INSURERS. 7. SIGN THE ENTRY FORM UNDER THE DECLARATION OF INDEMNITY. 8. PLEASE ENSURE THAT YOU HAVE ENCLOSED THE CORRECT ENTRY FEE. ENTRY FEE CLOSING DATE Normal Rate £150 Friday 11th July 2008 Entry Fee in Sterling only please. Please make cheques payable to: MAIDEN CITY MOTOR CLUB LTD. Entries to be sent to: Donna Carlin 176 Highmoor Road Eglinton BT47 3HS PRESS, RADIO, AND TV INFORMATION SHEET CAR No PLEASE COMPLETE IN BLOCK CAPITALS QUESTION FIRST DRIVER SECOND DRIVER NAME Date of Birth Birthplace Occupation Address Home Home Telephone No’s Business Business Hobbies other than Rallying How long competing in Rallies? Best 3 Rally results Have you done the Dogleap Rally before? Your best results Married? Which regional TV company serves your area Which local radio stations serves your area Names of local newspapers Make Capacity Details of car Group Car History (Details of special interest) PLEASE COMPLETE THIS ENTRY FORM USING BLOCK CAPITALS. PLEASE ENSURE THAT YOU HAVE COMPLETED ALL SECTIONS CORRECTLY BY REFERING TO THE REGULATIONS WHERE APPLICABLE. 1. DRIVER NAVIGATOR ENTRANT SURNAME FIRST NAME ADDRESS POSTCODE DAYTIME/MOBILE Please attach copy of TEL No Entrant’s Licence if an NATIONALITY Entrant is specified. COMP.LIC.No ISSUED BY DATE OF BIRTH 2. ADDRESS TO WHICH CORRESPONDENCE SHOULD BE SENT (DRIVER / NAVIGATOR) 3. DETAILS OF CAR Make Model Year of Manuf Cubic Capacity Group Class F.I.A. No 4. IF A REFUND OF ENTRY FEE HAS TO BE PAID, INDICATE TO WHOM IT SHOULD BE PAID DRIVER NAVIGATOR ENTRANT 5. SEEDING ORDER APPLICATION FORM Please enter details of results achieved by the first driver only (as a first driver) during the past two years. This information is for your benefit and if not received by the organisers, they will have no choice but to place you at the end of the seeded entry list. Overall Position Event Year Position in Class INTERNATIONAL EVENTS NATIONAL EVENTS OTHER EVENTS PLACINGS IN CHAMPIONSHIPS OTHER EVENTS 6. Name and Address of Insurers NEXT OF KIN DRIVER NAVIGATOR NAME Address Telephone Number 7. Declaration of Indemnity By the very fact of signing the entry form, the entrant, as well as the crew members submit themselves to the sporting jurisdictions specified in the International Sporting Code of the FIA and accept unreservedly these regulations, the General Regulations of the Motor Sports Association (MSA). “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 potential risk inherent with motor sport and agree to accept the risk. Further, I understand that all persons having any connection with the promotion and/or organisation and/or conduct of the event are insured against loss or injury caused through their negligence. I declare that the use of the vehicle hereby entered will be covered by insurance a required by law which is valid for such part of this event as shall take place on roads as defined by the law. If I an 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 the event and the General Regulations of the MSA.” As the Parent/Guardian/Guarantor: “I confirm I have acquainted myself with the MSA General Regulations, and agree to pay and 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 Section Z. Note: Where 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. Signature of Driver Date Signature of Navigator Date Signature of Parent or Guardian Date (If under 18 years of age) Amount Enclosed Entry Fee at Standard Rate £150.00 __________ Entry Fee at Late Rate N/A __________ Club Membership ~ Driver £10.00 __________ Club Membership ~ Navigator £10.00 __________ Shakedown Fee N/A __________ Total Amount Enclosed £ __________ LATE OR TELEPHONE ENTRIES WILL NOT BE ENTERTAINED For Official Use Only Number Received Acknowledged Amount in Sterling Class