Chris Kelly Memorial Manx Stages 2022

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

Home Town

Telephone Number

Mobile Number You cannot sign on until this is filled in

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

Competition Licence Issuer 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

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 (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

Co-Driver

Full Name This must be filled in to continue

Address

Post Code

Home Town

Telephone Number

Mobile Number You cannot sign on until this is filled in

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

Competition Licence Issuer 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

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 (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

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

Forced Induction

No

Yes

Four Wheel Drive

No

Yes

In Car Camera Request

No

Yes

FIA Homologation Number

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

Insurers

Name

Address

First Service Crew

Contact Name

Contact Number

Second Service Crew

Contact Name

Contact Number

Third Service Crew

Contact Name

Contact Number

Fourth Service Crew

Contact Name

Contact Number

Fifth Service Crew

Contact Name

Contact Number

Service Vehicle

Make

Model

Registration

Service Vehicle Length

Contact Name

Contact Number

Recce 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.

Championships

ANWCC Stage Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

The Mintex HRCR Stage Masters Challenge

Crew Members Registered

None

Driver

Co-Driver

Both

Motorsport UK Apshalt Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

SD34 MSG Stage Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

WAMAC J D Tyres Welsh Tarmacadam Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

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 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 like to recce?

Sunday 25 September 2022

Thursday 29 September 2022

When would you prefer to scrutineer?

Thursday 29 September 2022

Friday 30 September 2022

Fees - see above for how to pay

Entry Fee

£

Club Membership

£

Insurance

£

Optional donation to the Marshals Fund

£

Carbon Positive Motorsport Offset

£

Total Money to be sent

£

Payment Method and Details This must be filled in to continue

Telephone/Online transfer with Receipt number & drivers name as reference

Entrant (if applicable and not driver)

Name

Address

Post Code

Telephone Number

Nationality

Competition Licence Number

Competition Licence Issuer

Club Membership No

Marshal Details

Name

Mobile Number

Email Address

Experience

Comments

Anything else you'd like to tell us (Include name of people requiring membership)

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 to be allowed to pass on your Name, Address, Post Code and email addresses to Special Stage 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.

No

Yes

The event is not currently open for entries

Chris Kelly Memorial Manx Stages 2022 - Internet Entry Form

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