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DONEGAL INTERNATIONAL RALLY 2013

The Competition will be held under the International Sporting Code of the FIA, the General Competition Rules of Motorsport Ireland (the ASN) and the regulations as published

PLEASE CHECK YOU HAVE DONE THE FOLLOWING


1 2 3 4 5 6 7 8 9 10 ENTERED ALL THE DETAILS OF THE FIRST DRIVER, SECOND DRIVER AND ENTRANT ENTERED THE ADDRESS TO WHICH ALL CORRESPONDENCE SHOULD BE SENT ENTERED THE DETAILS OF THE CAR PLEASE INDICATE TO WHOM A REFUND SHOULD BE MADE ENTER SEEDING ORDER INFORMATION PRIORITY CLAIM - IF ANY PLEASE GIVE NAME AND ADDRESS OF INSURERS (Non MI/MSA licence holders only) OBTAIN STAMP OF NATIONAL CLUBS IF APPLICABLE ENTER TROPHY ELIGIBILITY SIGN THE ENTRY FORM UNDER THE DECLARATION OF INDEMNITY PLEASE COMPLETE THE BIOGRAPHY PLEASE ENSURE YOU HAVE ENCLOSED THE CORRECT ENTRY FEE

ENTRY FEE'S, MAP BOOKLET ORDER & CLOSING DATES EVENT TITLE International Rally National Rally Historic Rally Junior Rally ENTRY FEE'S 975 975 700 350 CLOSING DATE 18:00hrs 17th May 2013 18:00hrs 18:00hrs 18:00hrs 17th May 2013 17th May 2013 17th May 2013

PLEASE MAKE CHEQUES PAYABLE TO: DONEGAL MOTOR CLUB LTD.


EURO ONLY PLEASE INCLUDE MAP BOOKLET FEE IF ORDERED (For sterling rate please ring 00353877700015)

Entries to be sent to: Suzanne Mulhern, Loughros Point, Ardara, Co. Donegal. 0877700015

IMPORTANT I was a Donegal MC member in 2011 I was a Donegal MC member in 2012 I am a Donegal MC member in 2013 I am a First Time Rally Competitor

Please Tick

Please indicate which event you wish to compete in: Donegal International Rally Donegal National Rally Donegal Historic Rally Donegal Junior Rally

Map Booklet Order 30 each

booklets @30 =

ENTRY FORM
PLEASE COMPLETE THIS ENTRY FORM USING BLOCK CAPITALS. PLEASE ENSURE THAT YOU HAVE COMPLETED ALL SECTIONS CORRECTLY BY REFERING TO THE REGULATIONS WHERE APPLICABLE

FIRST DRIVER SURNAME FIRST NAME

SECOND DRIVER

ENTRANT

ADDRESS

ENTRANTS LICENCE No:

DAYTIME TELEPHONE No NATIONALITY COMPETITION LIC No ISSUED BY: NEXT OF KIN NAME: NEXT OF KIN CONTACT NUMBER E-MAIL CONTACT

CORRESPONDENCE SHOULD BE SENT TO:FIRST DRIVER SECOND DRIVER


YEAR OF MANUF

ENTRANT

DETAILS OF CAR
MAKE MODEL C.C GROUP CLASS F.I.A. No

IF A REFUND OF ENTRY FEE HAS TO BE SENT, INDICATE TO WHOM IT SHOULD BE PAID FIRST DRIVER SECOND DRIVER ENTRANT

SEEDING ORDER APPLICATION FORM Please enter details of results achieved by the FIRST Driver only (as a first driver from January 2011 to closing date) information is for your benefit & if not received by the organizers, they will have no choice but to place you at the end of the seeded entry list)
EVENT YEAR OVERALL POSITION POSITION IN CLASS

INTERNATIONAL EVENTS NATIONAL EVENTS OTHER EVENTS PLACINGS IN CHAMPIONSHIPS PRIORITY ENTRY CLAIM see article 6.5

Name & Address of Insurers (Non MI/MSA licence holders only) __________________________________________________________________________ For Foreign Entries Stamp of A.S.N Additional Awards Claim Please indicate below the awards for which you are eligible Full eligibility requirements are stated in Article 26 Declan Gannon Award Fanad Development Award Trevor Fleming Award Ford of Ireland Award Clifford Agnew Award

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9. Declaration of Indemnity
(a) I have read the supplementary regulations issued for this event and agree to be bound by them and by the General Competition Rules and Regulations of MI including the guidelines and regulations contained in Motorsport Irelands Code of Conduct for Childrens Sport. In consideration of the acceptance of this entry or of my being permitted to take part in this event I agree to save harmless and keep indemnified the Donegal Motor Club, Irish Automobile Club Ltd. t/a Royal Irish Automobile Club, Irish Motorsport Federation Ltd. t/a Motorsport Ireland and their respective officials, servants, representatives and agents from and against all actions, claims, costs, expenses and demands in respect of death, injury, loss of or damage to the person or property of myself, my driver(s), passenger(s) or mechanic(s) (as the case may be) howsoever caused arising out of or in connection with this entry or my taking part in this event and notwithstanding that the same may have been contributed to or occasioned by the negligence of the said bodies, their officials, servants, representatives or agents. Furthermore, in respect of any parts of this event on ground where Third Party Insurance is not required by law, this Agreement shall in addition to the parties named above extend to all and any other competitor(s) and their servants and agents and to all actions, claims, costs, expenses and demands in respect of loss of or damage to the person or property of myself, my driver(s), passenger(s) or mechanic(s). My age (driver) is (if applicable, state "over 18 years"). My age (co-driver) is (if applicable, state "over 18 years"). (b) I declare that to the best of my belief the driver(s), passenger(s) possess the standard of competence necessary for an event of the type to which this entry relates and that the car entered is suitable and roadworthy for the event having regard to the course and the speeds which will be reached. I declare that the use of the car hereby entered is covered by Insurance as required by the Road Traffic Act, which is valid for such part of this event as shall take place on roads as defined in the Act. (c) I understand that should I at the time of this event be suffering from any disability whether permanent, temporary or otherwise which is likely to affect prejudicially my normal control of my automobile, I may not take part unless I have declared such disability to MI, who have, following such declaration issued a licence which permits me to do so. (d) I undertake that at the time of the event to which this entry relates I shall be in possession of a current certificate of medical fitness. In the case of MI Licence Holders, only certificates on the official MI or FIA Medical Forms will be accepted. (e) Any indemnity and/or declaration as prescribed by sub-paragraphs (a) and (b) above which is signed by a person under the age of 18 years shall be countersigned by that persons parent or guardian, whose full names and address shall be given. Furthermore, the parents and/or guardians of persons under 18 years of age shall grant permission to MI and the Irish Sports Council to carry out tests in accordance with the Irish Anti-Doping Rules (Rule No 139) in the following form: I/We hereby grant permission to MI and the Irish Sports Council to carry out tests as set out in Rule No 139 of the GCRs in accordance with the Irish Anti-Doping Rules. Signature of First Driver _____________________________________________Date:____________ Signature of Second Driver ___________________________________________Date:____________ Signature of Parent/Guardian ________________________________________Date:____________ (If under 18 years of age) Signature of Entrant ________________________________________________Date:____________

For Official Use Only

Received

Acknowledged

Amount in Euro

Class

Number

PRESS, RADIO & TV INFORMATION SHEET


QUESTION
NAME DATE OF BIRTH BIRTHPLACE OCCUPATION

FIRST DRIVER

SECOND DRIVER

ADDRESS

TELEPHONE

HOBBIES OTHER THAN RALLYING

HOW LONG COMPETING IN RALLIES

BEST 3 RALLY RESULTS

HAVE YOU DONE THE DONEGAL INTERNATIONAL RALLY BEFORE YOUR BEST RESULTS MARRIED/SINGLE WHICH REGIONAL TV COMPANY SERVES YOUR AREA

WHICH LOCAL RADIO STATIONS SERVE YOUR AREA

NAMES OF LOCAL NEWSPAPERS

DETAILS OF CAR CAR HISTORY (Details of special


Interest)

MAKE

MODEL

CC