Alan Healy Memorial Rally 2024 - Internet Entry Form

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

Driver

Full Name This must be filled in to continue

Address You cannot sign on until this is filled in

Post Code You cannot sign on until this is filled in

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

E-Mail Address This must be filled in to continue

Club You cannot sign on until this is filled in

Club Membership No You cannot sign on until this is filled in

Driver Publicity

Hobbies

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

Mobile Number

Competition Licence Number 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

Co-Driver Publicity

Hobbies

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 This must be filled in to continue

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

Class You cannot sign on until this is filled in

A - Rally2, R5 and S2000 specification cars and any derivatives therefrom, plus World Rally cars with a sequential gearbox

B - 4-wheel drive cars over 2000cc or forced induction engines over 1500cc that are not eligible for Class A, including FIA Rally3 cars

C - 2-wheel drive cars with normally aspirated engines over 2000cc or forced induction engines over 1500cc, plus all FIA RGT cars

D - Cars with normally aspirated engines over 1600cc up to 2000cc or forced induction engines up to 1500cc, plus all FIA Rally4 or R2 cars with forced induction

E - Cars with normally aspirated engines over 1400cc up to 1600cc or forced induction engines up to 1000cc not included in Class D, plus all FIA Rally5 cars

F - Cars with normally aspirated engines up to 1400cc

In Car Camera Request

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

2023/24 MGJ Engineering Circuit Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

The Alpha Concrete ANEMMC Stage Rally Championship 2024

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

The 2024 Clubman Motorsport EMAMC Stage 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

Your Start Number

Seeding - Competitor Opinion

Out of 80 entries, where do you think you should be seeded? You cannot sign on until this is filled in

Scrutineering

When would you prefer to scrutineer? You cannot sign on until this is filled in

Saturday 30th March 1600-2000

Sunday 31st March 0700-0830

Fees - see above for how to pay

Entry Fee

£

Club Membership

£

Total Money to be sent

£

Payment Method and Details

Bank Transfer Payment

Entrant (if applicable and not driver)

Name

Address

Post Code

Telephone Number

Competition Licence Number

Club Membership No

Comments

Anything else you'd like to tell us

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, Post Code and email addresses to [INSERT VIDEO COMPANY HERE] and [INSERT PHOTO COMPANY HERE] 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

Bank:	Lloyds TSB
Sort Code:	30-97-44
Account No:	33200368
Account Name:	Border Motor Club Ltd
Reference:	Drivers Name

Alan Healy Memorial Rally 2024 - Internet Entry Form

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