The Pentraeth Glyn Memorial Stages 2021

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

Driver's name (as on your Motorsport UK Competition Licence - no nicknames please) 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 if under 18 years old

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

Co-Driver's name (as on your Motorsport UK Competition Licence - no nicknames please). 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 if under 18 years old

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 You cannot sign on until this is filled in

Model You cannot sign on until this is filled in

Colour

Registration Number

CC

4WD

No

Yes

Class This must be filled in to continue

A - Up to and including 1400cc

B - 1401cc up to and including 1600cc

C - 1601cc up to and including 2000cc

D - 2001cc and over

E - Road Rally class (as per 2021 Blue Book)

F - Formula 1000

H - HRCR Mini Sport Cup

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

Event WhatsApp Group

Mobile number for inclusion in group to receive notifications.

Event - YOU MUST SELECT AN OPTION

Which event do you wish to enter? This must be filled in to continue

The Pentraeth Glyn Memorial Stages

The Pentraeth Glyn Memorial Junior Stages

Championships

JD Tyres Welsh National Tarmacadam Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

ANWCC Stage Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

ANWCC North Wales Stage Rally Challenge

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

ANWCC Ladies Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

ANWCC Allrounders Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Junior 1000 Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

HRCR Mini Sport Cup

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

Event Name

Year

Status

O/A Position

Class Position

Fees - see top of page for details of how you can pay

Entry Fee

£

Total Money to be sent

£

Payment Method This must be filled in to continue

Paypal

Bank Transfer

Entrant (if applicable)

Name

Address

Post Code

Telephone Number

Competition Licence Number

Club Membership No

Garage

Would you like to be entered into the draw for a garage (see SR35) This must be filled in to continue

Yes

No

Comments / Championship registration numbers

Please write your Championship Registration No's and any other 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.

No

Yes

We would also like permission to pass on your email addresses to any officially approved video or photographic organisation attending at the venue so that they can contact you with a view to offering you videos and/or photos of you on the event. If you are happy to allow us to do this, please say so here.

No

Yes

The event is not currently open for entries

Bank	HSBC
Sort Code	40-16-02
Account No.	01166034
Account Name	C&A Motor Club
Reference	Driver's full name.

The Pentraeth Glyn Memorial Stages 2021 - Internet Entry Form

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