ATL Carlisle Stages 2018 - 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 You cannot sign on until this is filled in

Telephone Number You cannot sign on until this is filled in

Mobile Number You cannot sign on until this is filled in

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

Competition Licence Issuer

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

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 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 You cannot sign on until this is filled in

Driver Publicity

Hobbies

Married?

No of Children

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 You cannot sign on until this is filled in

Post Code You cannot sign on until this is filled in

Home Town You cannot sign on until this is filled in

Telephone Number You cannot sign on until this is filled in

Mobile Number You cannot sign on until this is filled in

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

Competition Licence Issuer

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

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 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 You cannot sign on until this is filled in

Co-Driver Publicity

Hobbies

Married?

No of Children

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 You cannot sign on until this is filled in

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

In Car Camera Request

FIA Homologation Number

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

Insurers

Name

Address

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

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

FUCHS Lubricants MSA British Historic Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Motorscope Northern Historic Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Rally 2WD Challenge

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

JORDAN ROAD SURFACING Gold Star Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

JORDAN ROAD SURFACING Silver Star Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

BTRDA 1400 Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

BTRDA Rally First Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

ST Trophy

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

BTRDA Rallye R2 Cup

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

BTRDA Historic Cup

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

BTRDA Production Cup

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Maxxis Tyres MSA English Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Border 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

Post Code

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

Post Code

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

Year

Type

Surface

Overall Position

Class Position

Scrutineering

Fees - see above for how to pay

Entry Fee

£

Club Membership

£

Insurance

£

Donation to Marshals £? up to you.

£

Management pack

£

Total Money to be sent

£

Payment Method and Details This must be filled in to continue

Cheque made Payable to 'Roger Albert Clark Rally Motor Club' Please write drivers full name on the back.

Bank transfer to, Sort Code 80 - 12 - 08 Account Number 06002797, Reference should contain the drivers full name

Entrant (if applicable and not driver)

Name

Address

Post Code

Telephone Number

Nationality

Competition Licence Number

Competition Licence Issuer

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

The event is not currently open for entries

ATL Carlisle Stages 2018 - Internet Entry Form

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