Legend Fires North West Stages 2019

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

Full Name This must be filled in to continue

Address

Post Code

Telephone Number

Mobile Number This must be filled in to continue

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

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

Married?

No of Children

How Long Rallying?

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

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

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

Married?

No of Children

How Long Rallying?

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

Forced Induction

No

Yes

Class You cannot sign on until this is filled in

A - up to 1400cc (including super 1000 cars)

B - 1401 - 1600cc

C - 1601 - 2000cc, 2 Wheel Drive

D - Over 2000cc, 2-Wheel Drive

E - All 4- Wheel Drive cars

F - upto 1000cc complying with F1000 technical regulations

H - Historic vehicles complying with R49

In Car Camera Request

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

Insurers

Name

Address

If you wish to use the road section insurance, can you comply with the Insurance Declaration quoted in the regulations? You cannot sign on until this is filled in

Yes - I wish to use the insurance and I comply with all points

No - I wish to use the insurance but do not comply (please contact me)

N/A - I have my own insurance

Recce Vehicle

Make

Model

Colour

Registration Number

Service Vehicle

Make

Model

Colour

Registration Number

Contact Name

Contact Number

Auxiliary Service Vehicle

Make

Model

Colour

Registration Number

Contact Name

Contact Number

Sponsor

Sponsor Name (Note: this sponsor does not need an entrant's licence.
If you have an entrant with an entrant's licence, please give details later.

Championships

ANCC Stage Rally Championships 2019 - please visit http://ancc.co.uk/stage-rally/ for more details - Registration is £5

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

ANWCC Stage Rally and All- Rounders Championship 2019 - please visit http://anwcc.co.uk for more details - Registration is £12

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

North of England Rally Championship 2019 - please visit http://www.nerallychamp.com/ for more details - Registration is £15

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

SD34 Stage Rally Championship/Individual Championship 2019 - please visit http://sd34msg.org.uk/ for more details - Registration is £5

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Novice as defined as H35.1.4

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

Mobile Number You cannot sign on until this is filled in

Relationship

Will this person be attending the event?

Person to be contacted in case of serious accident to Co-Driver

Name

Address

Post Code

Mobile Number You cannot sign on until this is filled in

Relationship

Will this person be attending the event?

Seeding - Past Performance on Stage Rallies by Driver Only
We can only seed you on the information you supply - please give as much detail as possible.

Event Name and Club

You must have finished at least 3 National B or higher stage rallies to enter this event.
If you don't have any further results to enter, please add N/A to rows 4 and 5.

Year

Type

Surface

Overall Position

Class Position

Seeding - Competitor Opinion

Out of 120 entries, where do you think you should be seeded?

Fees - see above for how to pay

Entry Fee

£

Club Membership

£

Insurance

£

Auxiliary Service Pack

£

Marshal Fund

£

Charity Donation

£

Motorhomes / Caravans - Service Area

£

Road Surface Damage Bond

£

Total Money to be sent

£

Payment Method and Details This must be filled in to continue

Stripe

BACS

Cheque (I will post a cheque/cheques to Entries Secretary)

Entrant (if applicable and not driver)

Name

Address

Post Code

Telephone Number

Competition Licence Number

Competition Licence Issuer

Club Membership No

Comments

Anything else you'd like to tell us

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 Special Stage TV and Pro-Rally Photography 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

Legend Fires North West Stages 2019 - Internet Entry Form

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

Seeding - Past Performance on Stage Rallies by Driver Only
We can only seed you on the information you supply - please give as much detail as possible.

Legend Fires North West Stages 2019 - Internet Entry Form

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

Seeding - Past Performance on Stage Rallies by Driver Only We can only seed you on the information you supply - please give as much detail as possible.

Seeding - Past Performance on Stage Rallies by Driver Only
We can only seed you on the information you supply - please give as much detail as possible.