Quinton 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 26th June at 10am

Entries Secretary: Nick Jones
134 Hamilton Avenue
Halesowen
West Midlands
B62 8SJ
Telephone 0121 503 0506
Mobile 07836 249930
e-mail: qsr.entries@qmc.org.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 Quinton Stages Rally 2010 On-line Entry system. Please follow the steps below to enter the rally.

Complete all the fields in the form below. The fields with red backgrounds are mandatory.
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.

There are then three ways to pay

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. Paying by Paypal will incur a 3.5% fee, which is added on to the total due.

If you have internet or telephone banking, you can arrange for the fees to be paid directly into our account. You need to pay Ł100 now, with the balance payable no later than the 19th June. The details are:-

Bank	HSBC
Sort Code	40-20-27
Account No.	41548204
Account Name	Quinton Motor Club Ltd
Reference	Driver's full name.

You can send a cheque, or 2 cheques if paying in instalments, made payable to 'Quinton Motor Club Ltd' to the Entries Secretary at the address above. One should be for Ł100 which will be banked on receipt, the second for the balance, which will be banked on the 26th June.

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.
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 qsr.entries@qmc.org.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.

Please provide any missing information or advise any changes by e-mail as soon as you are aware of them and as far as possible prior to arriving at the event.

Document Addressing

E-Mail address for communication

Real Name of this person

Whom should we send Finals and Results to?

Driver
Co-Driver

How would you like to receive Finals and Results?

E-mail/Website
Posted Paper

Driver

Full Name

Address

Post Code

Telephone Number

Mobile Number

Competition Licence Number

Competition Licence Issuer

E-Mail Address

Club

Date of Birth

Co-Driver

Full Name

Address

Post Code

Telephone Number

Mobile Number

Competition Licence Number

Competition Licence Issuer

E-Mail Address

Club

Date of Birth

Car

Make

Model

Colour

Registration Number

Engine Capacity

Forced Induction / Rotary engine

No
Yes

Four Wheel Drive

No
Yes

Class

Class RF10 - Cars up to and including 1000cc that comply with the BTRDA® Rally First Technical Regulations including cars complying with current F1000 regulations
Class RF14 - Cars over 1000cc up to and including 1400cc that comply with the BTRDA® Rally First Technical Regulations
Class 1.4L - All FIA Group N1 cars and cars that comply with a recognised ‘One Make Challenge’ technical specification.
Class 1.4C - Cars up to and including 1400cc with a maximum of 8 valve engines, plus all cars up to and including 1000cc not eligible for Class RF1.0
Class 1.4S - All other non homologated cars up to and including 1400cc and all current and former FIA Group A5 cars.
Class N3 - Current and former FIA Group N cars over 1400cc up to and including 2000cc
Class N4 - Current and former FIA Group N cars over 2000cc and FIA Super 2000 cars.
Class B10 - Over 1400cc up to and including 1600cc
Class B11 - Over 1600cc up to and including 2000cc
Class B12 - Over 2000cc two wheel drive
Class B13 - Over 2000cc four wheel drive that do not qualify for Class N4 or WR1
Class WR1 - Over 2000cc four wheel drive car with a sequential gearbox.
Class H1 - All cars complying with 2009 MSA Technical Regulations R 49.1
Class H2 - All cars complying with 2009 MSA Technical Regulations R 49.2
Class H3 - All cars complying with 2009 MSA Technical Regulations R 49.3

In Car Camera Request?

FIA Homologated ? Yes / No

Insurers details if NOT using Richard Egger Scheme

Name

Address

Service Vehicle

Make

Model

Colour

Registration Number

Contact Name

Contact Number

Auxiliary Service Vehicle (If required)

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

Silverstone Tyres BTRDA Gold Star Championship

None
Driver
Co-Driver
Both

Silverstone Tyres BTRDA Silver Star Championship

None
Driver
Co-Driver
Both

Millers Oils BTRDA 1400 / F1000 Championship

None
Driver
Co-Driver
Both

BTRDA S1000 Rally Championship

None
Driver
Co-Driver
Both

BTRDA Rally First Challenge

None
Driver
Co-Driver
Both

MG ZR Rally Challenge

None
Driver
Co-Driver
Both

In Car Services Welsh Clubman Rally Championship

None
Driver
Co-Driver
Both

AWMMC Heart of England Rally Championship

None
Driver
Co-Driver
Both

ANWCC Forest Rally Championship

None
Driver
Co-Driver
Both

ANWCC Historic Stage Rally Championship

None
Driver
Co-Driver
Both

HRCR Rally Challenge

None
Driver
Co-Driver
Both

HRCR Mini Cup

None
Driver
Co-Driver
Both

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 Rallies

Event Name and Club	Year	Type	Surface	Overall Position	Class Position

Scrutineering

When would you prefer to scrutineer?

Friday 3pm
Friday 4pm
Friday 5pm
Friday 6pm
Friday 7pm

Rally First Entrants:- Is this your first forest rally?

No
Yes

Would you like your Road Book posting?

No
Yes

Fees - see above for how to pay

Entry Fee

Quinton Motor Club 2010 Membership

Insurance

Colour maps (3 maximum per car)

Auxiliary Service Pack

Total Money to be sent

How will you pay? (Transfer / Credit Card(by PayPal) / Cheque)

Entrant (if applicable and not driver)

Name

Address

Post Code

Telephone Number

Competition Licence Number

Competition Licence Issuer

Comments

Comments:

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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