Wern Ddu 2019 Internet Entry Form

Entries Close on Thursday 24th October 2019 

Entries Secretary - Jessica Crawley or contact Steve Ellison via mobile 07902 017494

(E) wernddu.pca@hotmail.com

Held under the General Regulations of the Motor Sport UK

Welcome to Warrington  & District Motor Club   Clubmans Production Car Autotest 27th October  2019 Online Entry system. Please follow the steps below to enter the PCA.

  1. Complete all the fields in the form below. 
  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. The entry fee is £35  payable in full.
  4. Within 24 hours of us receiving the payment or deposit  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. 
    Please remember, your entry is NOT accepted until we receive Full Payment.
  5. 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 wernddu@hotmail.com

For payment, please either pay via BACS,  Stripe, or send a cheque payable to "Warrington & District Motor Club" to address above.

All the fields must be filled in or your entry will not be accepted. 

Document Addressing
E-Mail address for communication
Real Name of this person
Driver
Full Name
Address
Post Code
Home Town
Telephone 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
Co-Driver
Full Name
Address
Post Code
Home Town
Telephone Number
Mobile Number
E-Mail Address
Club
Date of Birth
Co-Driver's Parent or Guardian (under 18 only)
Name
Address (if different)
Post Code
Telephone Number
Relationship
Car
Make
Model
Colour
Registration Number
Engine Capacity
Forced Induction
Class
Service Vehicle
Sponsor
Championships
Association of North Western Car Clubs Championships 2019
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
SD(34) Motorsport Group Championships 2019
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
Telephone Number
Relationship
Will this person be attending the event?
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?
Fees - see above for how to pay
Entry Fee £
Club Membership £
Insurance £
Marshal Fund£
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
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.

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 Motorsport UK  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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