The Premier Rally 2009 Internet Entry Form

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

Entries Close for seeding on Thursday 12th November 10am

Entries Secretary: Joanne Smith
12 Breckbank
Forest Town
Mansfield
Notts
NG19 0PZ

Telephone 01623 480410
e-mail: entries@premier-rally.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 Revolution Wheels / S.A. Gas / Rallitrak Premier Rally - 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 THREE ways to pay
    1. If you have internet or telephone banking, you can arrange for the fees to be paid directly into our account. The details are:-
      Bank Co-operative Bank
      Sort Code  08-92-99
      Account No.  65342240
      Account Name Dukeries MC Events Account
      Reference Driver's First name and Surname
    2. Please send a cheque made payable to 'Dukeries Motor Club Ltd'  to the Entries Secretary at the address above. This will be banked on Tuesday 10th November.PLEASE ENSURE YOU PUT THE DRIVERS NAME ON THE REVERSE OF THE CHEQUE FOR REFERENCE PURPOSES.
    3. You can also use Paypal by visiting the Home page of the event website, www.premier-rally.co.uk The fees for each item include the administration charges required by Paypal.
    4. Within 24 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.
  4. 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@premier-rally.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
Competition Licence Issuer
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 - Class 1 - Cars up to and including 1400cc
2 - Class 2 - Cars over 1400cc and up to and including 1600cc
3 - Class 3 - Cars over 1600cc and up to and including 2000cc
4 - Class 4 - 2 Wheel Drive Cars Over 2000cc
5 - Class 5 - 4 Wheel Drive Cars Over 2000cc
H1 - Class H1 - Cars up to 1600cc excluding Lotus/Ford Twin Cam engined cars
H2 - Class H2 - Cars over 1600cc to 2000cc inc. Lotus/Ford Twin Cam engine cars BUT excluding Porsche 911's
H3 - Class H3 - Cars over 2000cc, including Porsche 911's
H4 - Class H4 - Cars up to 1600cc excluding Lotus / Ford Twin Cam engined cars
H5 - Class H5 - Cars over 1600cc to 2000cc, including Lotus / Ford Twin Cam engined cars
H6 - Class H6 - Cars over 2000cc and all Twin Cam multi valve engined cars
H7 - Class H7 - Cars up to 1600cc excluding Lotus / Ford Twin Cam engined cars
H8 - Class H8 - Cars over 1600cc to 2000cc, including Lotus / Ford Twin Cam engined cars
H9 - Class H9 - Cars over 2000cc and all Twin Cam multi valve engined cars
Insurers
Name
Address

Auxiliary Service Vehicle Details

Make
Model
Colour
Registration Number
Contact Name
Contact Number
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

Ward Construction / M-Tech Developments AEMC Stage Rally ChampionshipNo
Driver Only
Co-Driver Only
Both Crew Members
Roadrunner Phoenix Awards ANEMMC Stage Rally ChampionshipNo
Driver Only
Co-Driver Only
Both Crew Members
Competition Car Insurance EMAMC Stage Rally ChampionshipNo
Driver Only
Co-Driver Only
Both Crew Members
Motoscope Northern Historic Rally 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 Position

Class Position

Fees - see above for how to pay

Entry Fee £

Dukeries Motor Club Membership till 31st December 2010

£
Insurance£
AUXILIARY Service Vehicle Pack£
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

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 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.."

I declare that the use of the vehicle hereby entered will be covered by insurance as required by the law, which is valid for such part of the event that shall take place on roads as defined by the law.

I understand that should I, at the time of the event be suffering from any disability whether permanent or temporary which is likely to affect prejudicially my control of the 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.

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