ECMC Norman Perren Car Trial Online Entry Form

Online Entry Form

Eastern Counties Motor Club

Norman Perren Memorial Trial

Seckford Hall

1st January 2025

Driver Details:

Driver Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

Town/City

Post Code

Phone

Mobile*

E-mail Address*

for Final Instructions and Results

Your Motor Club*

Club Membership Number

Must be valid on 1st Jan 2025

MSUK License Number

RS Clubman / Competitor license

Vehicle Details:

Class Entered*

Make*

Model*

Reg No*

Engine Capacity (CC)*

Year of Registration*

LSD Fitted?*

NoYes

Passenger Details:

Passenger Name*

Anyone being a passenger for an U-18 driver must have a valid MSUK registered club membership.

E-mail Address

for Final Instructions and Results

Motor Club Name

Club Membership Number

Must be valid on 1st Jan 2025

MSUK License Number

RS Clubman / Competitor license

Is the car being entered by another Driver?*

YesNo

Other Driver Name

NOTE: A separate entry form is required for the each driver

Entry Details:

Is this your first Production Car Trial?*

YesNo

Entry fee is :

£40 per adult driver
£10 per U-18 driver
£20 for first time entrants (includes 2025 ECMC Membership).

Existing ECMC members can also renew their membership for 2025 by ticking the box below and adding their £10 membership fee to their entry payment.

Competitors who are not a member of one of the invited clubs (as listed in the event regulations), can apply to become a member of ECMC by ticking the relevant box below and adding their £10 membership fee to their entry payment.

Tick one of the boxes if you wish to renew your ECMC membership for 2025, or for competing non-members to join ECMC.

I wish to renew my ECMC Membership for 2025 - I will add my £10 club membership to my entry feeI wish to join ECMC for 2025 - I will add £10 club membership to my entry fee

Your entry is provisional until your payment has been received and verified.

Payment Method*

BACS - Transfer to 23-05-80 51481356, "Eastern Counties Motorsport Club", please use Driver Name as the payment reference.Cheque - payable to "Eastern Counties Motorsport Club"

Declaration of Indemnity:

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 competent to do so. I acknowledge that I understand the nature and type of competition and the potential risk inherent with motor sport and agree to accept that risk. Further I understand that all persons having connection with the promotion and/or organisation and/or conduct of the event are insured against loss or injury caused through the 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 this event as shall take part on roads as defined by the law.

Under the provision of the Data Protection Act 1985, Eastern Counties Motor Club requires your permission to hold the information on this entry form on a computer for the purpose of producing address lists, results and other such data for running the event. Clicking the checkbox below gives the organisers the right to hold this information.

I confirm that I have read Declaration of Indemnity and agree with it*

Yes

If the driver is under 18 years of age this form must be countersigned by a parent or guardian.

Parent/Guardian Declaration:

I am the parent/guardian of the driver. I understand that I have the right to be present during any procedure being carried out under the Supplementary Regulations issues for this event and the General Regulations of the MSA. As the parent/guardian I confirm that I have acquainted myself with the MSA General Regulations, agree to pay any appropriate charges and fees pursuant to these regulations (to include any appendices thereto) and hereby agree to be bound by these regulations and submit myself without reserve to the consequences resulting from those regualtions (and any subsequent alteration thereof). Further I agree to pay as liquidated damages any fines imposed upon me to the maximum set out in Part 3 Appendix 1 of the MSA Blue Book.

Note: Where the parent/guardian is not present on the day, there must be a representative who must produce a written and signed authorisation to so act from the parent/guardian as appropriate.

Parent/Guardian Name

Relationship to Driver

Parent/Guardian Address

This entry is made with my consent

Yes

Next of Kin details:

Name*

Relationship to driver*

Phone Number*

Entry Status*