Entry Form - Chelmsford Motor Club

CHELMSFORD MC
Motorsport Club of Chelmsford Limited
1956 – 2015
Celebrating 59 Years of Motorsport
C
M
C
March Hare 12 Car Rally – 20th March 2015
The event will be based from The Red Lion, 6 Church Hill, Finchingfield, Essex CM7 4NN.
Map Ref: 167/686328
Total distance will be approximately 60 miles through the highways and byways of Essex and Suffolk.
Fuel is available in Finchingfield, where scrutineering will be carried out. Scrutineering is at
Jesmonds Garage, Bardfield Road, Finchingfield, CM7 4LT between 6:45 and 7:30. Map Ref:
167/685 325.25.
Cars will leave MTC1 at one-minute intervals starting at 2001 hours.
OS Landranger series map 154 (D2) and 167 (C3) were used to prepare the clues. A small section of
map 155 (D2) is also used so it you have this map please bring it along. As a precaution, the section
of map 155 will be included with the Route Cards. Navigation will be checked on other versions and
advised.
Final Instructions and Entry List will be published around the 18th March 2015.
The Officials of the event are as follows:
Event Secretary/
Clerk of the Course
Entries Secretary
- Graham Robinson
07777 692 022
graham.e.robinson@btinternet.com
- Jim Drake
07764 574605
cooperfix@btinternet.com
Please note that entries will be accepted according to the series common regulations for completed,
signed entry forms with payment, by post to the address below. Entries from experts will remain
provisional until one week before the event, when they will become firm if spaces are available. Emails or
web posts will not guarantee an entry.
Cars will be subject to scrutineering and noise testing. Particular attention will be paid to auxiliary
lighting and other PR sensitive factors, as well as vehicle safety factors.
Please be ready to produce V5 and MOT certificates. The Scrutineer has the power to exclude any
vehicle which fails scrutineering.
Entries from drivers not meeting the insurance pre-conditions cannot be accepted after 8th March 2015.
Those that meet the criteria will be accepted up until the day of the event.
President Bill Preston – Chairman Jim Bowie – Secretary Paul Barrett – Treasurer Richard Nel – Competition Secretary Tony Michael
ENTRY FORM
Please send completed entry forms to:
Jim Drake
47, Dunlin Rd.,
Grove Hill,
Hemel Hempstead,
HP2 6LY.
Please make sure your entry form is complete and you have enclosed the appropriate fee.
DRIVER
Name
Address
E-mail
Home Tel No
Work Tel No
Mobile Tel No
Club
NAVIGATOR
Name
Address
E-mail
Home Tel No
Work Tel No
Mobile Tel No
Club
CAR DETAILS
Model
Make
Colour
Reg No
C.C.
Master
Expert
CLASS
Novice
Beginner
President Bill Preston – Chairman Jim Bowie – Secretary Paul Barrett – Treasurer Richard Nel – Competition Secretary Tony Michael
The Organisers have applied to Jelf Insurance Partnership for a Blanket Cover Note under the above scheme. This will
provide competitors who need to use the scheme with the Third Party Cover necessary to meet RTA requirements on the
Road Sections of the event.
The basic rate for the event before any loadings will be £12.50. All applicants wishing to use the scheme must be able to
comply with all points of the Jelf Insurance Partnership’s Declaration: -
I do not have the Third Party Road Section extension on my current Motor Insurance.
I am aged 20 or over.
I have had no more than 1 fault claim in the last three years
I have no more than maximum of 6 conviction points on my UK driving licence
I have the appropriate competition licence as well as a UK/EU driving license and if my license is provisional
I will be supervised by an adult over 25.
I have no physical or mental disabilities
I have no other material facts to disclose
Anyone aged less than 20 years old will also be accepted at the same price should their co-driver be a more senior member
of their family or over 25.
If you comply with all points above no Letter of Acceptance will be required. If unable to comply with any of the above
points you will be required to complete the Declaration form (the form can be obtained by contacting the event secretary or
Jelf Insurance Partnership) which should be forwarded either to the organisers or direct to Jelf Insurance Partnership
prior to the event to allow sufficient time for a letter of acceptance to be issued.
Jelf Insurance Partnership
Partnership House
Priory Park East
Kingston Upon Hull
HU4 7DY
Tel + 44 (0) 1482 213215
Fax + 44 (0) 1482 213216
Email info@jelfmotorsport.com
President Bill Preston – Chairman Jim Bowie – Secretary Paul Barrett – Treasurer Richard Nel – Competition Secretary Tony Michael
INSURANCE
Jelf Insurance Partnership cover required
YES /
NO
Own Insurers Details (if not using Jelf)
FEES
Entry Fee (under 21s free)
£10.00
JIP Insurance (no loading)
£12.50
JIP Insurance (with loading – amount TBA by JIP)
CMC Membership
£
£10.00
Total
Cheques must be made payable to “Motor Sport Club of Chelmsford Ltd”
Indemnification and Declaration
I have read the Supplementary Regulations issued for this event and agree to be bound by them and
by the General Regulations of The Motor Sports Association. In consideration of the acceptance of
this entry and of my being permitted to take part in this event, in respect of any parts of the event
not held on a publicly adopted road, I agree to save harmless and keep indemnified The Motor Sports
Association, such Person, Persons or Body as may be authorised by The Motor Sports Association to
promote or organise this event and their respective Officials, Servants, Representatives and Agents
together with other Competitors and their respective Servants, Representatives and Agents from
and against all actions, claims, expenses and demands in respect of Death of or injury to or Damage
to the Property of myself, my Driver(s), Passenger(s), Mechanic(s) or associated personnel, arising
out of or in connection with this entry or my taking part in this event.
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 this event as shall take place on roads as defined by the law.
President Bill Preston – Chairman Jim Bowie – Secretary Paul Barrett – Treasurer Richard Nel – Competition Secretary Tony Michael
Drivers Signature
Age (if under 18)
Next of Kin, Name and
Phone Number
Navigators Signature
Age (if under 18)
Next of Kin, Name and
Phone Number
If a competitor is under 18 years of age, this form must be countersigned by the appropriate Parent
or Guardian who must attend the event and sign on as their entrant.
“This entry is made with my consent”
Parent or Guardian of Driver
Name
Address
Relationship
Tel No
Signature
Parent or Guardian of Navigator
Name
Address
Relationship
Tel No
Signature
President Bill Preston – Chairman Jim Bowie – Secretary Paul Barrett – Treasurer Richard Nel – Competition Secretary Tony Michael