Rex Pet Hotel Flying Fortress Stages 2021

Document Addressing

E-Mail address for communication.

Without a functioning e-mail address we cannot contact you and send event info.

Please supply a valid address. 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

Driver

First name and Surname (TBA / TBC not acceptable) This must be filled in to continue

Address You cannot sign on until this is filled in

Post Code You cannot sign on until this is filled in

Contact Telephone Number You cannot sign on until this is filled in

Competition Licence Number This must be filled in to continue

E-Mail Address This must be filled in to continue

Club You cannot sign on until this is filled in

Club Membership No

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 (per K10.3.1) 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 (per K10.3.1) 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

First name and Surname (TBA / TBC not acceptable) This must be filled in to continue

Address You cannot sign on until this is filled in

Post Code You cannot sign on until this is filled in

Contact Telephone Number You cannot sign on until this is filled in

Competition Licence Number This must be filled in to continue

E-Mail Address This must be filled in to continue

Club You cannot sign on until this is filled in

Club Membership No

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 (per K10.3.1) 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 (per K10.3.1) 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

Car

Make This must be filled in to continue

Model This must be filled in to continue

Colour You cannot sign on until this is filled in

Registration Number You cannot sign on until this is filled in

Engine Capacity You cannot sign on until this is filled in

Forced Induction This must be filled in to continue

No

Yes

Four Wheel Drive This must be filled in to continue

No

Yes

Class This must be filled in to continue

0 - Class 0 - Cars up to 1000cc

1 - Class 1 - Cars over 1000cc up to and including 1400cc

2 - Class 2 - Cars over 1400cc up to and including 1600cc

3 - Class 3 - Cars over 1600cc up to and including 2000cc

4 - Class 4 - Cars over 2000cc - 2WD

5 - Class 5 - Cars over 2000cc - 4WD

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

Additional Person 1

Name of first additional person / service crew (Please put None if not attending) You cannot sign on until this is filled in

Mobile Number of first additional person / service crew (Please put None if not attending) You cannot sign on until this is filled in

Additional Person 2

Name of second additional person / service crew (Please put None if not attending) You cannot sign on until this is filled in

Mobile Number of second additional person / service crew (Please put None if not attending) You cannot sign on until this is filled in

Additional Person 3

Name of third additional person / service crew (Please put None if not attending) You cannot sign on until this is filled in

Mobile Number of third additional person / service crew (Please put None if not attending) You cannot sign on until this is filled in

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

Clubman Motorsport EMAMC Stage Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Alpha Concrete ANEMMC Stage Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Marsh Commercial Stage Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Dukeries MC Championship

Crew Members Registered

None

Driver

Co-Driver

Both

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 You cannot sign on until this is filled in

Will this person be attending the event? You cannot sign on until this is filled in

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 You cannot sign on until this is filled in

Will this person be attending the event? You cannot sign on until this is filled in

Seeding - Past Performance on Rallies

Event Name and Club

Year

Type

Surface

Overall Position

No of Starters

Seeding - Competitor Opinion

Out of 70 entries, where do you think you should be seeded?

Fees - see above for how to pay

Entry Fee £270

£

Dukeries MC Membership till 31/12/2021

£

Total Money to be sent

£

Entrant (if applicable and not driver)

Name

Address

Post Code

Telephone Number

Competition 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.

The event is not currently open for entries

Bank	Co-operative Bank
Sort Code	08-92-99
Account No.	65342240
Account Name:	Dukeries MC Events Account
Reference	Driver's First name and Surname

Rex Pet Hotel Flying Fortress Stages 2021 - Internet Entry Form

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