THE TYNESIDE STAGES RALLY 2022 - Internet Entry Form

Document Addressing

E-Mail address for communication This must be filled in to continue

Real Name of this person This must be filled in to continue

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

Name as to be shown on entry list This must be filled in to continue

Address

Post Code

Telephone Number

Mobile Number

Competition Licence Number You cannot sign on until this is filled in

E-Mail Address

Club You cannot sign on until this is filled in

Club Membership No You cannot sign on until this is filled in

Date of Birth

Nationality

Helmet Make You cannot sign on until this is filled in

Helmet Model You cannot sign on until this is filled in

Helmet Approval Standard (per K10.3.1) You cannot sign on until this is filled in

FHR Make You cannot sign on until this is filled in

FHR Model You cannot sign on until this is filled in

FHR Approval Standard (per K10.3.1) You cannot sign on until this is filled in

Driver's Parent or Guardian (under 18 only)

Name

Address (if different)

Post Code

Telephone Number

Relationship

Co-Driver

Name as to be shown on entry list This must be filled in to continue

Address

Post Code

Telephone Number

Mobile Number

Competition Licence Number You cannot sign on until this is filled in

E-Mail Address

Club You cannot sign on until this is filled in

Club Membership No You cannot sign on until this is filled in

Date of Birth

Nationality

Helmet Make You cannot sign on until this is filled in

Helmet Model You cannot sign on until this is filled in

Helmet Approval Standard (per K10.3.1) You cannot sign on until this is filled in

FHR Make You cannot sign on until this is filled in

FHR Model You cannot sign on until this is filled in

FHR Approval Standard (per K10.3.1) You cannot sign on until this is filled in

Co-Driver's Parent or Guardian (under 18 only)

Name

Address (if different)

Post Code

Telephone Number

Relationship

Car

Make You cannot sign on until this is filled in

Model You cannot sign on until this is filled in

Colour

Registration Number

Engine Capacity

Year

Forced Induction

No

Yes

Four Wheel Drive

No

Yes

Class You cannot sign on until this is filled in

1 - Vehicles up to and including 1400cc

2 - Vehicles 1401cc but no more than 1600cc

3 - Vehicles 1601cc but no more than 2000c

4 - Vehicles 2001cc and over but excluding those that fall into class 5

5 - Vehicles that are four wheel drive and turbocharged plus Metro 6R4s

6 - All historic cars as defined by 2022 MUK Tech Regs as per R49

In Car Camera Request

FIA Homologation Number

Competition Car Logbook/Passport Number You cannot sign on until this is filled in

Car Seats and Harnesses

Left Harness FIA Homologation Expiry Date You cannot sign on until this is filled in

Right Harness FIA Homologation Expiry Date You cannot sign on until this is filled in

Left Seat FIA Homologation Expiry Date You cannot sign on until this is filled in

Right Seat FIA Homologation Expiry Date You cannot sign on until this is filled in

Car Fire Extinguishers

Hand-held fire extinguisher make You cannot sign on until this is filled in

Hand-held fire extinguisher capacity You cannot sign on until this is filled in

Hand-held fire extinguisher last service date You cannot sign on until this is filled in

Plumbed-in fire extinguisher make You cannot sign on until this is filled in

Plumbed-in fire extinguisher capacity You cannot sign on until this is filled in

Plumbed-in fire extinguisher last service date You cannot sign on until this is filled in

Insurers

If using the event insurance, please state EVENT INSURANCE

Name

Address

Service vehicle

Make

Model

Colour

Registration Number

Contact Name

Contact Number

Championships

AS Performance North of England Tarmacadam Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

The Burnside Piling Scottish Tarmack Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

ANCC Proflex Shock Absorbers Stage Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

HRCR Motorscope Northern Historic Asphalt Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

SG Petch Stage Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

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

No of Starters

Seeding - Competitor Opinion

Out of 90 entries, where do you think you should be seeded?

Fees - see above for how to pay

Entry Fee

£

Club Membership

£

Insurance

£

Donation to the Marshals Fund

£

Total Money to be sent

£

Payment Method and Details This must be filled in to continue

Payment by Cheque

Payment by Credit Transfer

Entrant (if applicable and not driver)

Name

Address

Post Code

Telephone Number

Nationality

Competition Licence Number, this MUST be given or the Entrant will not be listed

Competition Licence Issuer

Club Membership No

Comments

Privacy and Permissions

We take your privacy seriously and will only use your personal information to administer your entry, including providing a public Entry List and sending you emails in connection with your entry. Some of your information will be passed on to the organisation providing results for the event.

We would also like to be allowed to contact you in the future to tell you about other events which we are running, including this event in future years. If you are happy to allow us to do this, please say so here.

No

Yes

The event is not currently open for entries

Bank	Barclays
Sort Code	20-58-17
Account No	60917141

THE TYNESIDE STAGES RALLY 2022 - Internet Entry Form

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