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Altratech 061 Road Rally 2017 Internet Entry Form

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

Rally Secretary: Mark Wilkinson, 74 Haslington Road, Ashway Park, Manchester, M22 5HU
0161 437 6425
entries@061roadrally.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 the Altratech 061 Road Rally 2017 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. 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@061roadrally.co.uk

Payment can be made:

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.

All the data entered on this page will be stored on a computer for the purposes of administering the entries for the 061 Road Rally, and will not be passed to any third parties.

Document Addressing
E-Mail address for communication
Real Name of this person
Driver
Full Name
Address
Post Code
Home Phone Number
Mobile Number
Competition Licence Number
E-Mail Address
Club
Date of Birth
Driver's Parent or Guardian (under 18 only)
Name
Address (if different)
Post Code
Telephone Number
Relationship
Navigator
Full Name
Address
Post Code
Home Phone Number
Mobile Number
Competition Licence Number
E-Mail Address
Club
Date of Birth
Navigator's Parent or Guardian (under 18 only)
Name
Address (if different)
Post Code
Telephone Number
Relationship
Car
Make
Model
Colour
Registration Number
Engine Capacity
Four Wheel Drive
Class - Navigator Performance
Insurers
Name
Address
Championships
Association of Northern Car Clubs
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Association of North Western Car Clubs
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Association of West Midland Motor Clubs
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
East Midland Association of Motor Clubs
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Premier HRCR
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
SD(34) Motor Sport Group
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Person to be contacted in case of serious accident to Driver
Name
Address
Post Code
Mobile Number
Relationship
Will this person be attending the event?
Person to be contacted in case of serious accident to Navigator
Name
Address
Post Code
Mobile Number
Relationship
Will this person be attending the event?
Seeding - Past Performance on Road Rallies
Event Name and ClubYearTypeResults?Overall PositionNo of Starters
Seeding - Competitor Opinion
Out of 60 entries, where do you think you should be seeded?
Fees - see above for how to pay
Entry Fee £
Club Membership £
Insurance £
Marshal Fund£
Breakfast£
Total Money to be sent£
Payment Method and Details
Marshal Details
Name
Address
Post Code
Telephone Number
Mobile Number
Email Address
Experience
Comments
Anything else you'd like to tell us

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, if any, 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.'

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