Rali Mike Darowen Bro Ddyfi 2019 Internet Entry Form

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

Rali Mike Darowen Bro Ddyfi 2019

R Keith Price Ltd and Tsalta Motorsport Ltd

Dovey Valley Motor Club Ltd

Document Addressing
E-Mail address for communication
Real Name of this person
Driver
Full Name
Address
Post Code
Mobile Number
Telephone 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
Mobile Number
Telephone 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
Class
Insurers
Name
Address
Championships
Welsh Association Motor Clubs Road Rally Championship
Crew Members Registered
Driver Championship Registration Number
Navigator Championship Registration Number
Association of North Western Car Clubs Road Rally Championship
Crew Members Registered
Driver Championship Registration Number
Navigator Championship Registration Number
Association of North Western Car Clubs All-rounder Championship
Crew Members Registered
Driver Championship Registration Number
Navigator Championship Registration Number
Association of North Western Car Clubs Ladies Rally Championship
Crew Members Registered
Driver Championship Registration Number
Navigator Championship Registration Number
Welsh Border Car Club Road Rally Championship
Crew Members Registered
Driver Championship Registration Number
Navigator Championship Registration Number
Eligible for Under 1425cc Award
Crew Members Registered
Driver Championship Registration Number
Navigator Championship Registration Number
Eligible for Mixed Crew Award
Crew Members Registered
Driver Championship Registration Number
Navigator Championship Registration Number
Eligible for Veteran Crew Award
Crew Members Registered
Driver Championship Registration Number
Navigator Championship Registration Number
Best DVMC Crew Award
Crew Members Registered
Driver Championship Registration Number
Navigator 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 Navigator
Name
Address
Post Code
Telephone Number
Relationship
Will this person be attending the event?
Seeding - Past Performance on Rallies
Event Name and ClubYearTypeOverall PositionNo of Starters
Seeding - Competitor Opinion
Out of 50 entries, where do you think you should be seeded?
Fees
Entry Fee £
Club Membership £
Insurance
Please ensure you refer to SR.22 before completing insurance 		£
MSA License Application£
Total Money to be sent£
Payment Method and Details- BACS payment or Cheque. NB if paying by cheque please make cheques payable to "DVMC" and post to entries secretary within 24 hrs of submitting entry form & if paying by BACS please put the driver name as the reference!

 

 

Bank account details are:

Dovey Valley MC Ltd

Nat West

Sort Code: 53-81-26

Account number: 3643 8413

Marshal Details
Name
Address
Post Code
Mobile Number
Telephone Number
Email Address
Experience
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.

We would also like to be allowed to pass on your Name, Address, Post Code and email addresses to [Brian Gibert] 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.

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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