Rod Brereton Hillclimb Scammonden June 2023

Welcome to PENDLE DISTRICT MOTOR Club Online Entry system. Please follow the steps below to enter the event.

Once you have hit the "Enter Event" button at the end you will receive an automated response confirming we have received your entry form.

PAYMENT FOR THIS EVENT IS BY BACS TRANSFER ONLY

BACS transfer direct to Pendle Districts Club account the entry fee is £90.00

Please put the drivers name in the reference field,to enable us to identify who has paid.

Within 24 hours of us receiving the payment for your entry you should receive an e-mail confirming your entry from the Entries Secretary

NOTE: WITHOUT PAYMENT YOUR ENTRY WILL NOT BE VALID. If you don't receive a response within 5 days of the expected payment date, or if you have any other questions, please e-mail the entries secretary at the address above.

Contact Infromation

E-Mail address for communication This must be filled in to continue

Contact Name This must be filled in to continue

Electronic Entry (Office Use Only!)

Yes

Driver

Full Name This must be filled in to continue

Address This must be filled in to continue

Post Code This must be filled in to continue

Telephone Number This must be filled in to continue

Mobile Number This must be filled in to continue

MSA Licence Number This must be filled in to continue

E-Mail Address This must be filled in to continue

MSA Affiliated Club
(of which I am a member) This must be filled in to continue

Date of Birth (if under 20 years of age)

Nationality

Helmet Make

Helmet Model

Helmet Approval Standard (per K10.3.1)

FHR Make

FHR Model

FHR Approval Standard (per K10.3.1)

Shared or Double Entries (You will still need to submit 2 entries)

Is this entry part of a shared entry?

Yes

Enter the name of the other competitor using this vehicle

Is this entry part of a double entry?

Yes

Driver's Parent or Guardian (under 20 only)

Name

Address (if different)

Post Code

Telephone Number

Relationship

Competition Licence Number

Competition Licence Issuer

Rod Brereton Hillclimb Scammonden June 2023 - Internet Entry Form

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

PAYMENT FOR THIS EVENT IS BY BACS TRANSFER ONLY