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held under the international sporting code of the fia

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					                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