Radnor Pacemaker Road Rally 2024 - Internet Entry Form

Entries Secretary: Barrie Philpott
19 Oak Meadow, Bishops Castle Shropshire SY95PA

Complete all the fields in the form below. The fields with red backgrounds are mandatory.

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

If you have internet or telephone banking, you can arrange for the fees to be paid directly into our account. The details are:-

NOTE: WITHOUT PAYMENT YOUR ENTRY WILL NOT BE VALID Within 24 hours of us receiving the payment for your entry you should receive an e-mail confirming your entry from Barrie.

If you don't receive a response within 3 days of the expected payment date, or if you have any other questions, please e-mail bazpott1966@gmail.com

All the fields with a red background must be filled in, or you will not be able to continue.

Please put TBA in any red field which you do not know the details for. (but send them as soon as you do!!)

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

Post Code

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

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

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'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

Class You cannot sign on until this is filled in

M - Master

E - Expert

S - Semi Expert

N - Novice

Insurers

Name

Address

Policy Number You cannot sign on until this is filled in

Bank	Barclays
Sort Code	206108
Account No.	40636940
Account Name	Knighton Motor Club
Reference	Drivers Name

Radnor Pacemaker Road Rally 2024 - Internet Entry Form

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