Summer Stages Rally 2019 - 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

Post Code

Telephone Number

Mobile Number This must be filled in to continue

Competition Licence Number This must be filled in to continue

Competition Licence Issuer This must be filled in to continue

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

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'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 This must be filled in to continue

Competition Licence Number This must be filled in to continue

Competition Licence Issuer This must be filled in to continue

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

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'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

Class You cannot sign on until this is filled in

A - 2WD Up to and including 1400cc

B - 2WD Over 1400cc, up to and including 1600cc

C - 2WD Over 1600cc, up to and including 2000cc

D - 2WD Over 2000cc, up to and including 3000cc

E - 2WD over 3000cc and All 4WD & Turbo powered cars

F - Cars up to 1000cc as per the current F1000 Rally Club Challenge 2019 regulations and/or Micra K11 regulations with the exception of tyres for non-championship registered contenders. Any 1000cc vehicles not complying with this requirement including Super 1000 must be entered in class A

H - Historic & Post Historic

G - Current or former WRC, R5, S2000, S2500

In Car Camera Request

No

Yes

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 This must be filled in to continue

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

Championships

Motor-Mall Manx Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

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

No of Starters

Seeding - Competitor Opinion

Out of 40 entries, where do you think you should be seeded? This must be filled in to continue

Fees - see above for how to pay

Entry Fee

£

Club Membership

£

Insurance

£

Total Money to be sent

£

Payment Method and Details This must be filled in to continue

Cheque made payable to Druidale Motor Club Limited

Telephone/Online transfer with drivers name as reference

Entrant (if applicable and not driver)

Name

Address

Post Code

Telephone Number

Competition Licence Number

Competition Licence Issuer

Club Membership No

Marshal Details

Name This must be filled in to continue

Telephone Number

Email Address

Experience

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.

The event is not currently open for entries

Bank	Isle of Man Bank
Sort Code	55-91-00
Account No.	10914315
Account Name	Druidale Motor Club Limited
Reference	Driver's full name.

Summer Stages Rally 2019 - Internet Entry Form

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