Visit Conwy Cambrian 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

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

Home Town 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

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

Competition Licence Issuer

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

Date of Birth

Nationality

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 This must be filled in to continue

Post Code This must be filled in to continue

Home Town 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

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

Competition Licence Issuer

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

Date of Birth

Nationality

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 You cannot sign on until this is filled in

Registration Number You cannot sign on until this is filled in

Engine Capacity You cannot sign on until this is filled in

Year You cannot sign on until this is filled in

Forced Induction You cannot sign on until this is filled in

No

Yes

Four Wheel Drive You cannot sign on until this is filled in

No

Yes

In Car Camera Request

In-Car Camera fitted

No in-car camera

Insurers details if NOT using REIS Scheme.

Note. If using the event's REIS Scheme, please insert 'EVENT REIS' into the below mandatory fields.

Name This must be filled in to continue

Address. This must be filled in to continue

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 (please contact me)

N/A - I have my own insurance

Recce Car details If BRC

Contact Name & Address

Contact Number

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

BRC - Motorsport UK Probite British Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Stellantis Motorsport Rally Cup IRE & UK

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Protyre BTRDA Rally Series

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Motorsport UK Pirelli UK Welsh Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

TCS Plant Rally Challenge supporting Wales Air Ambulance

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

ANWCC Forest/Ladies/Allrounder Championships

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

ANWCC Mini Cooper Rally Challenge

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 You cannot sign on until this is filled in

Address You cannot sign on until this is filled in

Post Code You cannot sign on until this is filled in

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 You cannot sign on until this is filled in

Post Code You cannot sign on until this is filled in

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

Overall Position

No of Starters

Seeding - Competitor Opinion

Out of 160 entries, where do you think you should be seeded?

Scrutineering

When would you prefer to scrutineer?

Friday 2 to 3 pm

Friday 3 to 4 pm

Friday 4 to 5 pm

Friday 5 to 6 pm

Friday 6 to 7 pm

Participating in Recce?

No

Yes

Fees - see above for how to pay

Entry Fee

£

Club Membership

£

Insurance

£

Overnight Parking Victoria

£

Team Entries

£

Total Money to be sent

£

Entrant (if applicable and not driver)

Name

Competition Licence Number

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.

Please refer to our Privacy Policy on www.northwalescarclub.co.uk

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.

Please refer to our Privacy Policy on www.northwalescarclub.co.uk

Yes

No

We would also like to be allowed to pass on your Name, Address, Post Code and email addresses to our official Video and Photo suppliers 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.

Please refer to our Privacy Policy on www.northwalescarclub.co.uk

Yes

No

Remember your entry is subject to fully completed form AND the correct entry fee. An automated acknowledgement is NOT confirmation of entry. Rejected entries and entries held in abeyance will be informed by e-mail to the address(es) given above.

To pay by bank transfer (online banking) payments should be made to Cambrian Rally Ltd, Sort Code 30-96-26, Account no 75995768. Please enter your entry receipt no and driver surname in the 'Reference' field

All entries must be fully completed and a £100 entry deposit paid to be valid. Your entry will not be accepted and you will not appear on any list of entries until a valid entry is received. Entry fees must be paid in FULL not later than 1200 hours on Saturday 12th October 2024, failing which a supplemental rate will be applied up to final closing at 18:00 on the 21st October 2024.

By clicking on the "Enter the Rally" button below you agree to the following: "I declare that I have been given the opportunity to read the General Regulations of Motorsport UK and, if any, the Supplementary Regulations for this event and agree to be bound by them. I declare that I am physically and mentally fit to take part in the event and I am competent to do so. I acknowledge that I understand the nature and type of the competition and the potential risk inherent with motor sport and agree to accept that risk. Further, I understand that all persons having any connection with the promotion and/or organisation and/or conduct of the event are insured against loss or injury caused through their negligence."