Golden Jubilee Dukeries Rally 2009 Internet Entry Form

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

Entries Close for seeding on 2nd June at 10am

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

Telephone 01623 480410
e-mail: entries@dukeries-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 RAINWORTH SKODA Golden Jubilee Dukeries 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 then TWO 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. You can send a cheque, or 2 cheques if paying in instalments, made payable to 'Dukeries Motor Club Ltd'  to the Entries Secretary at the address above. The first cheque for £50 will be banked upon receipt and the accompanying cheque for the balance of the entry fee will be banked on Wednesday 3rd June. In the payment method box please state  - "CHEQUE(S)" or "MONEY TRANSFER"
    3. Please select the appropriate entry fee from the drop down selection within the entry fee section.
    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@dukeries-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
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
ClassRF1.0 - Cars up to and including 1000cc that comply with the BTRDA Rally First technical regulations including cars complying with the current F1000 technical regulations.
RF1.4 - Cars up to and including 1400cc that comply with the BTRDA Rally First technical regulations.
1.4 L - All current and former FIA Group N1 cars & cars that comply with a recognised One Make Challenge tech. specifications. i.e.Ford Ka,Peugeot 206/1400,Daihatsu Cuore Avanzato & Nissan Micra Challenge
1.4 C - Cars up to and inc. 1400cc with a max. of 8 valve engines, plus all other cars upto and inc. 1,000cc not eligible for Class RF1.0. 1.4C cars must not be fitted with remote reservoir suspension
1.4 S - All other non-homologated cars up to and including 1400cc and all current and former FIA Group A5 cars.
N3 - Current & former FIA Group N cars over 1400cc up to and including 2000cc
N4 - Current & former FIA Group N cars over 2000cc and FIA Super 2000 cars.
B10 - Over 1400cc up to and including 1600cc
B11 - Over 1600cc up to and including 2000cc
B12 - Over 2000cc two wheel drive
B13 - Over 2000cc four wheel drive (including all Land Rover & Sierra 4x4 derivatives) that do not qualify for Class WR1.
WR1 - Any 4 wheel drive car based on a current or former World Rally Car and any 4 wheel drive car with an actual engine capacity over 2,800cc
H2 - For all cars registered and homologated before 1.1.75.
H3 - For all cars registered and homologated between 1.1.75 and 31.12.81.
FIA Homologation Number
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
Fostek Engineering ANCC 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
Millers Oils BTRDA 1400 ChampionshipNo
Driver Only
Co-Driver Only
Both Crew Members
Competition Car Insurance EMAMC Stage Rally ChampionshipNo
Driver Only
Co-Driver Only
Both Crew Members
Silverstone Tyres Gold Star ChampionshipNo
Driver Only
Co-Driver Only
Both Crew Members
MG ZR Rally ChallengeNo
Driver Only
Co-Driver Only
Both Crew Members
MSA English Rally ChampionshipNo
Driver Only
Co-Driver Only
Both Crew Members
BTRDA Rally First ChallengeNo
Driver Only
Co-Driver Only
Both Crew Members
Silverstone Tyres Silver Star 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

Scrutineering

We have limited availabilty for Saturday AM Scrutineering. Please indicate if required.

Saturday AM 7.30am till 8.15am

Fees - see above for how to pay

Entry Fee £

Dukeries Motor Club 2009 Membership

£
Insurance£
AUXILIARY Service Vehicle Pack£
Additional Service Vehicle Plate£
Total Money to be sent £
Payment Method and details

Entrant (if applicable and not driver)

Full Name
Address
Post Code
Telephone Number
Entrants 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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