EventSigns Woodpecker Stages Rally 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

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

Competition Licence Issuer

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

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'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

Competition Licence Issuer

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

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's Parent or Guardian (under 18 only)

Name

Address (if different)

Post Code

Telephone Number

Relationship

Competition Licence Issuer

Competing 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

Year (particularly for Historic Competitors)

Forced Induction

No

Yes

Four Wheel Drive

No

Yes

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

If you are using your own insurance for the rally please provide the name, policy number and address of the insurance company:

Insurer's name & policy number

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

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

BTRDA Gold Star Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

BTRDA Silver Star Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

BTRDA 1400 Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

BTRDA Rally First Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

BTRDA Production Cup

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

BTRDA Historic Cup

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Rallye R2 Cup

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

ST Trophy

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Motorsport UK English Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Motorsport UK Welsh Stage Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Welsh Historic Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

ANWCC Forest Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

RAC Rally 2WD Challenge

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?

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?

Seeding - Past Performance on Rallies (not necessary for drivers who have competed on BTRDA forest rallies in recent years)

Event Name and Club

Year

Surface

Overall Position

Class position

Fees - see above for how to pay

Entry Fee (see drop down options)

£

Sixty & Worcestershire MC Membership

£

JELF Insurance or Own - Please Select

£

Auxiliary Support Pack

£

Total Money to be sent

£

Payment Method and Details This must be filled in to continue

Bank Transfer

Cheque for full amount

Cheque for £100 plus second cheque for balance amount (see Regs Sect 7 for details)

Entrant (if applicable and not driver)

Name

Address

Post Code

Telephone Number

Entrants MSA Licence Number

Club Membership No

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 the Woodpecker Stages 2020. 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 Bank
Sort Code	20-98-61
Account No.	00663778
Account Name	Sixty and Worcs Rally Club
Reference	Driver's full name

EventSigns Woodpecker Stages Rally 2019 - Internet Entry Form

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