Coppermines Grizedale Stages Rally 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

Telephone Number You cannot sign on until this is filled in

Mobile Number

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

Issuing Authority : MS-UK (Motorsport UK) / Other (state)

E-Mail Address

Club You cannot sign on until this is filled in

Club Membership No

Date of Birth (if under 18) Note SR 8.4 (Competitors under 18 yrs old must submit to the entries secretary a hard copy of the entry form, signed by their parent or guardian, before the event)

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

Co-Driver

Full Name This must be filled in to continue

Address

Post Code

Telephone Number You cannot sign on until this is filled in

Mobile Number

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

Issuing Authority: MS-UK (Motorsport UK) / Other (state)

E-Mail Address

Club You cannot sign on until this is filled in

Club Membership No

Date of Birth (if under 18) Note SR 8.4 (Competitors under 18 yrs old must submit to the entries secretary a hard copy of the entry form, signed by their parent or guardian, before the event)

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

Car

Make This must be filled in to continue

Model This must be filled in to continue

Colour

Registration Number You cannot sign on until this is filled in

Engine Capacity You cannot sign on until this is filled in

Year

Forced Induction

No

Yes

Four Wheel Drive

No

Yes

Class You cannot sign on until this is filled in

Working - Cars up to 1400cc. (RF1.0, RF1.4, 1400S, 1400C)

Lower Middle - 1401cc to 1600cc. (B10, H1, H2)

Middle - 1601cc to 2000cc. (RF2.0, N3, B11, H3, H4)

Upper Middle - 2001cc and over (B12)

Upper - All 4WD cars. (N4, NR4, R2(B), B13, B14)

In Car Camera Request

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 - please include details unless you are using REIS (see section below)

Name

Address

Service Vehicle

Make

Model

Registration Number

Sponsor/s

Sponsor Name (Note: this sponsor does not need an entrant's licence)

Championships

ANECCC SG Petch Stage Rally Championship - Permit No. 2022/2

Crew Members Registered

None

Driver

Co-Driver

Both

Motorsport UK English Rally Championship - Permit No. 2022/8

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

Will this person be attending the event?

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

Will this person be attending the event?

Seeding - Past Performance on Rallies

Event Name and Club

Year

Type i.e Nat A / Nat B

Surface - loose / tarmac / forest

Overall Position

No of Starters

Seeding - Competitor Opinion

Out of 80 entries, where do you think you should be seeded?

Please read Section 10 of the Supplementary Regualtions - Scrutineering will take the form of traditional, physical scrutineering, and will include checks on crash helmets, flame-resistant overalls, FHR’s, camera mountings. We recommend hand sanitiser or wipes (minimum 60% alcohol) are carried in the car.

Fees - see above for how to pay

Entry Fee This must be filled in to continue

£

Club Membership

£

Insurance

£

Total Money to be sent

£

Payment Method - please state BACS or Paypal This must be filled in to continue

BACS

Paypal (incurs a 4% charge )

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

The event is not currently open for entries

Bank	NatWest
Sort Code	01-04-66
Account No.	80164420
Account Name	Grizedale Stages Rally
Reference	Driver's full name.

Coppermines Grizedale Stages Rally 2022 - Internet Entry Form

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