Builth Showground Stages 2019 - 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

Driver

Full Name This must be filled in to continue

Address

Post Code

Home Town

Telephone Number

Mobile Number

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

E-Mail Address

Motor 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

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 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 You cannot sign on until this is filled in

Driver Publicity

Hobbies

Notable Results

Any other information

Driver's Parent or Guardian (under 18 only)

Name

Address (if different)

Post Code

Telephone Number

Relationship

Competition Licence Number

Competition Licence Issuer

Co-Driver

Full Name This must be filled in to continue

Address

Post Code

Home Town

Telephone Number

Mobile Number

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

E-Mail Address

Motor 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

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 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 You cannot sign on until this is filled in

Co-Driver Publicity

Hobbies

Notable Results

Any other information

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

Name

Address (if different)

Post Code

Telephone Number

Relationship

Competition Licence Issuer

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

Eligible for "Best Mixed/Female Crew" Award

Yes

No

Eligible for "Best Novice Driver" Award (see article 16)

Yes

No

Eligible for "Best HMC Crew" Award (see article 16)

Yes

No

Class (see article 7) You cannot sign on until this is filled in

-

Class 1 - Cars up to and including 1400cc

Class 2 - Cars over 1400cc but no more than 1600cc

Class 3 - Cars over 1600cc but no more than 2000cc 16v

Class 3A - Cars over 1600cc but no more than 2000cc 8v

Class 4 - Cars over 2000cc

Class 5 - Road rally car

Class 6 - Historic

Class 7 - 4WD (Note - 3 second per mile penalty will be enforced)

In Car Camera Request (See article 22) Equipment MUST be installed prior to scrutineering.

Yes

No

Competition Car Logbook 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

Championships

CMSGCC 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?

Yes

No

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?

Yes

No

Seeding (see article 8) - Past Performance on Rallies of driver only

Event Name and Club

Year

Type

Surface

Overall / Class Position

No 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 (valid until 31st December 2020)

£

Donation to the Marshals Fund (£5 per smiley badge)

£

Total Money to be sent

£

Payment Method and Details This must be filled in to continue

Payment by Credit Transfer (details at top of form)

Entrant (if applicable and not driver)

Name

Address

Post Code

Telephone Number

Competition Licence Number

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.

Yes

No

We would also like to be allowed to pass on your Name, Address, Post Code and email addresses to [INSERT VIDEO COMPANY HERE] and [INSERT PHOTO COMPANY HERE] so that they can contact you with a view to offering you videos and photos of you on the event. If you are happy to allow us to do this, please say so here.

Yes

No

The event is not currently open for entries

Bank	Barclays
Sort Code	20-39-64
Account No	30478881

Builth Showground Stages 2019 - Internet Entry Form

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