Get Jerky Rally North Wales National 2023

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

Whom should we send Finals and Results to?

Driver

Co-Driver

Both Driver and Co-Driver

Driver

Full Name This must be filled in to continue

Address

Post Code

Home Town

Telephone Number (Daytime)

Mobile Number

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

Telephone Number (Evening)

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 18 years or under

Nationality

Driver Publicity

Hobbies

Married?

No of Children

How Long Rallying?

Notable Results

Any other information

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

Home Town

Telephone Number (Daytime)

Mobile Number for use prior to and during the event

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

Telephone Number (Evening)

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 18 years or under

Nationality

Co-Driver Publicity

Hobbies

Married?

No of Children

How Long Rallying?

Notable Results

Any other information

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

Engine Capacity

Year

Forced Induction

No

Yes

Four Wheel Drive

No

Yes

Camera Request

No

Yes

Competition Car Logbook Number You cannot sign on until this is filled in

Insurers

Name

Address

Service Crew Details

Emergency Contact Name of Service Crew member for use during the event

Emergency Contact Mobile phone number of Service Crew member for use during the event

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

Motorsport UK British Historic Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Motorsport UK Ravenol Welsh Forest Rally Championship in association with Pirelli

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

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

Fees - see above for how to pay

Entry Fee

£

Club Membership

£

Insurance

£

Mandatory GPRS/GPS tracking system @ £35 Each

£

Get Jerky Rally North Wales Event Programme @ £5 Each

£

Total Money to be sent

£

Payment Method and Details This must be filled in to continue

Entrant (if applicable and not driver)

Name

Address

Post Code

Telephone Number

Mobile Number for use during the event in case of emergency

Competition Licence Number

Team Name

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.

AGREEING TO PROVIDE YOUR EMAIL ADDRESS AND HOME ADDRESS YOU ARE ALLOWING THE CLUB TO USE YOUR DETAILS FOR THE PROMOTION OF ACTIVITIES THAT THE CLUB ORGANISES AND PROMOTES IN ACCORDANCE WITH THE GDPR REGULATIONS, WHICH YOU GAVE AS DATED ABOVE.

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.

Yes

No

We would also like to be allowed to pass on your Name, Address, Post Code and email addresses to a partner 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.

Yes

No

The event is not currently open for entries

Get Jerky Rally North Wales National 2023 - Internet Entry Form

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