Anglesey Aggregates Palferman Road Rally 2023

Document Addressing

E-Mail address for communication - PLEASE ENTER CAREFULLY. This must be filled in to continue

Real Name of this person This must be filled in to continue

Driver

Name (as it appears on your competition licence). 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 This must be filled in to continue

Club Membership No This must be filled in to continue

Date of Birth if under 21 years old

Driver's Parent or Guardian (under 18 only)

Name.

Address (if different)

Post Code

Telephone Number

Relationship

Navigator

Name (as it appears on your competition licence) 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 This must be filled in to continue

Club Membership No This must be filled in to continue

Date of Birth if under 21 years old

Navigator'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

Class You cannot sign on until this is filled in

1 - Expert

2 - Semi Expert

3 - Novice

Insurers

Will you be using Marsh Sport's Insurance scheme? See SR 10. This must be filled in to continue

Yes

No

If you have your own insurance cover, you must provide the name and address of the company and your policy number.

If you wish to use the road section insurance, can you comply with the Insurance Declaration quoted in the regulations? You cannot sign on until this is filled in

Yes - I wish to use the insurance and I comply with all points.

No - I wish to use the insurance but do not comply.

N/A - I have my own insurance.

Championships

ANWCC Registered Competitors.

Crew Members Registered

No crew member registered.

Driver registered.

Navigator registered.

Both crew members registered.

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

Person to be contacted in case of serious accident to Navigator

Name

Address

Post Code

Telephone Number

Relationship

Seeding - Past Performance on Rallies

Event Name

Year

Status

Class Entered

Class Position

Overall Position

Fees - see above for how to pay

Entry Fee

£

Insurance - NOTE - click here to select the option of own insurance or to select the Marsh Sport cover at £29 for the standard premium with no loading. This must be filled in to continue

£

Total Money to be sent

£

Payment Method and Details This must be filled in to continue

Bank Transfer - details at top of page. Reference = PALF and driver's name.

PayPal - details at top of page. Reference PALF and driver's name.

Marshal Details

Name You cannot sign on until this is filled in

Mobile Number You cannot sign on until this is filled in

Email Address

Car Registration Number You cannot sign on until this is filled in

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.

Yes

No

We would also like to be allowed to pass on your name, address, postcode and email addresses to the event photographer so that he can contact you with a view to offering you 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

Anglesey Aggregates Palferman Road Rally 2023 - Internet Entry Form

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