Wildlife Smeatharpe Stages 2024 - Internet Entry Form

Driver

Full Name

Address

Post Code

Home Town (Important for Media)

Telephone Number

Mobile Number

Competition Licence Number

Competition Licence Issuer & grade

E-Mail Address This must be filled in to continue

Club

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

Date of Birth

Nationality

Helmet Make You cannot sign on until this is filled in

Helmet Model You cannot sign on until this is filled in

Helmet Approval Standard (per K10.3.1) You cannot sign on until this is filled in

FHR Make You cannot sign on until this is filled in

FHR Model You cannot sign on until this is filled in

FHR Approval Standard (per K10.3.1) You cannot sign on until this is filled in

Driver & Car Commentary Info

Profession?

How Long Rallying?

Notable Results

History of car & any notable results?

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

Address

Post Code

Home Town (Important for Media)

Telephone Number

Mobile Number

Competition Licence Number

Competition Licence Issuer & Grade

E-Mail Address

Club

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

Date of Birth

Nationality

Helmet Make You cannot sign on until this is filled in

Helmet Model You cannot sign on until this is filled in

Helmet Approval Standard (per K10.3.1) You cannot sign on until this is filled in

FHR Make You cannot sign on until this is filled in

FHR Model You cannot sign on until this is filled in

FHR Approval Standard (per K10.3.1) You cannot sign on until this is filled in

Co-Driver Publicity

Profession?

How Long Rallying?

Notable Results

Any other information the commentator can use about you, the driver or the car....

Co-Driver's Parent or Guardian (under 18 only)

Name

Address (if different)

Post Code

Telephone Number

Relationship

Competition Licence Issuer

Car

Make

Model

Colour

Registration Number

Engine Capacity

Year

Forced Induction / Rotary engine

No

Yes

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

Front

Rear

4WD

Class You cannot sign on until this is filled in

A - Up to 1400cc

B - 1401cc to 1600cc

C - 1601cc to 2000cc

D - Over 2000cc

E - All 4 Wheel Drive

In Car Camera Request?

We will not have a camera

We will have a camera

FIA Homologated ? Yes / No

Competition Car Logbook Number You cannot sign on until this is filled in

Car Seats and Harnesses

Left Harness FIA Homologation Expiry Date You cannot sign on until this is filled in

Right Harness FIA Homologation Expiry Date You cannot sign on until this is filled in

Left Seat FIA Homologation Expiry Date You cannot sign on until this is filled in

Right Seat FIA Homologation Expiry Date You cannot sign on until this is filled in

Car Fire Extinguishers

Hand-held fire extinguisher make You cannot sign on until this is filled in

Hand-held fire extinguisher capacity You cannot sign on until this is filled in

Hand-held fire extinguisher last service date You cannot sign on until this is filled in

Plumbed-in fire extinguisher make You cannot sign on until this is filled in

Plumbed-in fire extinguisher capacity You cannot sign on until this is filled in

Plumbed-in fire extinguisher last service date You cannot sign on until this is filled in

Championships

ASWMC DL Motorsport Parts Ltd Stage Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

BP Motor Bodybuilders & Engineers - CMSGCC 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

Class Position

Seeding - Competitor Opinion

Out of 65 entries, where do you think you should be seeded?

Fees - see above for how to pay

Entry Fee

£

Sponsor a Marshal

£

Total Money to be sent

£

Payment Method and Details This must be filled in to continue

Bank Transfer

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

Please provide any missing information or advise any changes by e-mail as soon as you are aware of them and as far as possible prior to arriving at the event.

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.."