Three Shires Stages 2019 - Internet Entry Form

Entries Close for seeding on Friday 23rd August at 20:00

Please note the Entry Fee is £525

Entries Secretary: Andrew Isherwood

Telephone: 07780 701765
E-mail: entries@threeshiresstages.co.uk

PLEASE NOTE: YOUR ENTRY WILL NOT BE ACCEPTED UNTIL YOU HAVE COMPLETED AND ENTERED YOUR THREE NATIONAL B RALLY RESULTS

Held under the General Regulations of Motorsport UK (incorporating the provisions of the International Sporting Code of the FIA) and the Supplementary Regulations

Welcome to the Three Shires Stages 2019 Online Entry system. Please follow the steps below to enter the rally.

Competitors under the age of 18 will require the signature of their parent or guardian as Guarantor. A Guarantor is expected to attend the event and sign-on as an entrant. If they are unable to be present a representative can attend but must produce the Guarantor's written and signed authorisation to act on their behalf.

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

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?

Website

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

Competition Licence Issuer

E-Mail Address

Club - See Article 5 (Competitor Eligibility) in the regs. You cannot sign on until this is filled in

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

Date of Birth (if under 18).

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 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

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

Home Town

Telephone Number

Mobile Number

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

Competition Licence Issuer

E-Mail Address

Club - See Article 5 (Competitor Eligibility) in the regs. You cannot sign on until this is filled in

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

Date of Birth (if under 18).

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 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

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 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

Contact Name

Contact Number

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.

Person to be contacted in case of serious accident to Driver

Name You cannot sign on until this is filled in

Address

Post Code

Telephone 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 You cannot sign on until this is filled in

Address

Post Code

Telephone Number You cannot sign on until this is filled in

Relationship

Will this person be attending the event?

Seeding - Past Performance on Rallies - Please Note: Drivers must have completed at least THREE National B Stage Rallies. (As per SR5 & SR10)

Event Name and Club

Year

Type

Surface

Overall Position

No of Starters

Seeding - Competitor Opinion

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

Recce + Scrutineering

When would you prefer to Scrutineer?

14:00 - 15:45

15:45 - 17:30

17:30 - 19:00

What times would you prefer to Recce? (If this time is in conflict with your scrutineering time please ensure you have a team in place to take your car to scrutineering OR change your Recce or Scrutineering Time)

12:30 - 14:00 then 15:00 - 16:30

13:15 - 14:45 then 15:45 - 17:15

14:00 - 15:30 then 16:30 - 18:00

Not doing Recce

Fees - Payable by BACS,Card (Stripe), Cheque or Cash. Details at top of form.

Entry Fee

Club Membership

Insurance

Total Money to be sent

Payment Method and Details This must be filled in to continue

BACS

Stripe

Cheque (I will post a cheque to the entries secretary)

Entrant (if applicable and not driver)

Name

Address

Post Code

Telephone Number

Nationality

Competition Licence Number

Competition Licence Issuer

Club Membership No

Comments

Any relevant 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

We would also like to be allowed to pass on your Name, Address, Post Code and email addresses to Special Stage TV and M&H 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

The event is not currently open for entries

Three Shires Stages 2019 - Internet Entry Form

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