The ARMSTRONG
GALLOWAY HILLS RALLY
Sunday 2nd DECEMBER 2007
 
Organised by
SOLWAY CAR CLUB * MACHARS CAR CLUB * EAST AYRSHIRE CAR CLUB
 
DECLARATION OF INDEMNITY

I declare that:
1. I have been given an 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.

 

2. 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.

 

3. The use of the vehicle hereby entered is covered by insurance as required by the law which is valid for such part of this event as shall take place on roads as defined by the law.

 

4. I understand that should I at any time of this event be suffering from any disability whether permanent or temporary which is likely to affect prejudicially my normal control of the vehicle, I may not take part unless I have declared such disability to the ASN, who have, following such declaration, issued a licence which permits me to do so.

 

5. Any application form for a Licence which was signed by a person under the age of 18 years was countersigned by that person’s parent/guardian/guarantor, whose full names and addresses have been given.

 

6. If I am 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 this event and the General Regulations of the MSA. As the Parent/Guardian/Guarantor I confirm that I have acquainted myself 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 maximum set out in Section Z
Note: Where the 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.

Date  03/07/2008
I accept the conditions of entry
Entrant: State age if under 18
Driver: State age if under 18
CoDriver: State age if under 18
In the event of an entry from a person under 18 years this form must be countersigned by a parent or guardian, whose name, address and relationship must be given.
Parent or Guardian  
Full Name and Address
Contact details of next-of-kin to be informed in the event of an accident:
Driver Name and address

Telephone (available to contact on day of event)
CoDriver Name and address

Telephone (available to contact on day of event)

CORRESPONDENCE
All correspondence will be sent to the Co-driver unless otherwise requested.
Note: If an email address is provided all correspondence will be sent by this method.

Please send all correspondence to:

Co-Driver Driver Entrant

ENTRY FORM

Entrant  
First Name
Last Name
Address
Post Town
Post Code
Telephone
Email Address*
(We will contact you on this address.)
Competition Licence Number
Competition Licence Type
 
Driver  
If the Entrant is also the Driver
'tick' this box to copy the details.		 (copy Entrant details to Driver)
First Name
Last Name
Address
Post Town
Post Code
Telephone
Email Address
Car Club
Competition Licence Number
Competition Licence Type
 
CoDriver  
If the Entrant is also the CoDriver
'tick' this box to copy the details		 (copy Entrant details to CoDriver)
First Name
Last Name
Address
Post Town
Post Code
Telephone
Car Club
Email Address
Competition Licence Number
Competition Licence Type
 
Car Details  
Make of Car
Model
Engine Capacity
Registration Number
Colour
Class Entered
 
Insurance  
I can comply with terms of Lockton Insurance Requirements
I cannot comply and therefore require an Lockton Insurance declaration form.
I have my own insurance
State full name of Insurers (If using own)
 
Details Of Fees Paid  
To confirm an entry a cheque / postal order (made payable to GALLOWAY HILLS RALLY A/C) must be forwarded to the Entries Secretary, before the closing date, until receipt of payment your entry will be held on the 'Provisional List', but your order of receipt secured by the date of this Online Entry.
Cheque / postal order number
Account Name
Entry Fee £420.00 (all classes)
Lockton Insurance £26.00
Service Pack and Marshals' Food Included
Total Paid £
 
Refund Details  
Please make any refund cheque payable to:
 
Seeding Information  
List up to four results by First Named Driver as a Driver in the past 2 years. See Also ASR's 10 and 25.
Category
claimed (A, B, C, D, E, F)
 
Date
Event
Start No.
Status
(International / Nat A / Nat B)
Position
O/A
Class
 
Eligibility for Marque Awards  
The Maconochies Trophy - 1st Group N Car
The James Haugh Trophy - 1st GM Car
The Gemmell Trophy - 1st Ford Car
The Thomas Corrie Trophy - 1st Rover Group Car
The James Brown Trophy - 1st Peugeot Talbot Car
Trophy - 1st Subaru Car
Trophy - 1st Mitsubishi Car
The Lawrance Clark Trophy - Highest placed Co-driver resident in DG Postal Area
The Fred Patterson Award - Highest rated Irish competitor (at the organisers' discretion)
The George Rutherford Trophy - Highest placed Female Driver (failing which, co-driver)
The highest placed ALL East Ayrshire Car Club crew Award