The Turbo Centre Twyford Stages Rally 2010 Internet Entry Form

Entries to this event are now closed and this page is for record only

Entries Close for seeding on 11th April 2010

Entries Secretary: Claire Simms
6 Penfold Way
Morton
Derbyshire
DE55 6HS

Telephone 01773 875138

e-mail: entries@mid-derbyshiremc.co.uk Held under the General Regulations of the Motor Sports Association (incorporating the International Sporting Code of the FISA) and the Supplementary Regulations

Welcome to The Turbo Centre Twyford Stages Rally 2010 Online Entry system. Please follow the steps below to enter the rally.

  1. Complete all the fields in the form below. The fields with red backgrounds are mandatory.
  2. Once you have hit the "Enter the Rally" button at the end you will receive an automated response confirming we have received your entry form.
  3. There are then two ways to pay
    1. If you would like to pay via credit or debit card, you will get a link at this point to take you to Paypal's website, where you can pay for your entry by card. Note that we do not see your card details at all, this is all handled for us by Paypal.
    2. You can send a cheque, made payable to 'Rally Account' to the Entries Secretary at the address above.
  4. Within 48 hours of us receiving the payment for your entry you should receive an e-mail confirming your entry from the Entries Secretary. NOTE: WITHOUT PAYMENT YOUR ENTRY WILL NOT BE VALID.
  5. If you don't receive a response within 3 days of the expected payment date, or if you have any other questions, please e-mail entries@mid-derbyshiremc.co.uk

All the fields with a red background must be filled in, or you will not be able to continue. Please put TBA in any red field which you do not know the details for.

Document Addressing
E-Mail address for communication
Real Name of this person
Whom should we send Finals and Results to? DriverCo-Driver
How would you like to receive Finals and Results?E-mail/WebsitePosted Paper
Driver
Full Name
Address
Post Code
Telephone Number
Mobile Phone Number
Competition Licence Number
E-Mail Address
Club
Date of Birth
Co-Driver
Full Name
Address
Post Code
Telephone Number
Mobile Phone Number
Competition Licence Number
E-Mail Address
Club
Date of Birth
Car
Make
Model
Colour
Registration Number
Engine Capacity
Forced InductionNo
Yes
Four Wheel DriveNo
Yes
Class1 - Cars up to and including 1400cc
2 - Cars over 1400cc but no more than 1600cc
3 - Cars over 1600cc but no more than 2000cc
4 - Cars over 2000cc
5 - All 4x4
In Car Camera Request
Sponsor
Sponsor Name
Note: This sponsor does not need an entrant's licence. If you have an entrant with an entrant's licence, please give details later.

Championships

Association of Eastern Motor Clubs 2010 ChampionshipNo
Driver Only
Co-Driver Only
Both Crew Members
Association of Northern Car Clubs 2010 ChampionshipNo
Driver Only
Co-Driver Only
Both Crew Members
Association of North East Midlands Motor Clubs 2010 ChampionshipNo
Driver Only
Co-Driver Only
Both Crew Members
Association of North West Car Clubs 2010 ChampionshipNo
Driver Only
Co-Driver Only
Both Crew Members

Person to be contacted in case of serious accident to Driver

Name
Address   
Post Code
Telephone Number
Relationship
Will this person be attending the event?

Person to be contacted in case of serious accident to Co-Driver

Name
Address  
Post Code
Telephone Number
Relationship
Will this person be attending the event?

Seeding - Past Performance on Stage Rallies by Driver Only

We can only seed you on the information you supply - please give as much detail as possible

Event Name and ClubYearTypeSurfaceOverall PositionNo of Starters
Seeding - Competitor Opinion
Out of 90 entries, where do you think you should be seeded?

Scrutineering

Please indicate your preferred Scrutineering Day. Note that preference is given to early entries.

Saturday 4-6pm
Sunday

Fees - see above for how to pay

Entry Fee £

Mid-Derbyshire Motor Club Ltd 2010 Membership

£
Forestry Camping Charge£
Donation to D,L,R, Air Ambulance£
Total Money to be sent £
Payment Method and Details

Entrant (if applicable and not driver)

Full Name
Address
Post Code
Telephone Number
Competition Licence Number
Anything else you'd like to tell us

The details on this form will be held on computer in order to be used for the administration of this event. They will also be used to send you information about future events organised by this club, unless you untick this box to indicate you do not wish to receive information on further events.
The details on this form may also be passed on to other motorsport organisations, unless you untick this box to indicate you do not wish these details passed on.

Remember your entry is subject to receipt of the correct entry fee. An automated acknowledgement is NOT confirmation of entry. Rejected entries and entries held in abeyance will be informed by e-mail to the address(es) given above.

By clicking on the 'Enter the Rally' button below you agree to the following: '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. 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.'

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