Rallynuts Motorsport Tour of Epynt 2019

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

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

Date of Birth of driver if under 18 years old You cannot sign on until this is filled in

Is this the Driver's 1st time on Epynt as a Driver? This must be filled in to continue

YES

NO

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

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

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

Forced Induction

No

Yes

Four Wheel Drive

No

Yes

Class You cannot sign on until this is filled in

1 - Cars up to and including 1400cc

2 - Cars 1401cc up to and including 1600cc

3 - Cars 1601cc up to and including 2000cc

4 - Cars 1601cc up to and including 2000cc, 4 cylinder 8 valve (normally aspirated)

5 - Cars 2001cc and over – 2 wheel drive

6 - Cars 2001cc and over – 4 wheel drive

7 - Group N cars

8 - Road Rally Cars - As per MSA Regulations

9 - Non-homologated current or former WRC or one derived from one + current and former S2000 cars and all FIA R5 cars.

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

Own Insurers (If NOT using JELF event insurance)

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

Championships

Protyre MSA Asphalt Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

JD Tyres Welsh National Tarmacadam Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Promotive King of Epynt Challenge

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

FMP Rally Challenge

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

ANWCC Stage Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Fuchs Lubricants Classic Mini 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

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?

Drivers Seeding - Enter the best results achieved by the Driver ONLY (As a Driver, not as a Co-Driver), since 1st January 2011.

Event Name and Club

Year

Type

Surface

Overall Position

Position in Class

RECCE

Participating in Recce? (Details regarding Recce to be sent through with the Final Instructions). This must be filled in to continue

No

Yes

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 (Please put Driver/Navigator names on the rear of cheque)

BACS - (Please Enter Driver/Co-Driver Name in the Reference)

Entrant (if applicable and not driver)

Name

Address

Post Code

Telephone Number

Nationality

Competition Licence Number

Club Membership No

Comments

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	Barclays
Sort Code	20-84-41
Account No.	40750743
Account Name	Port Talbot Motor Club Ltd
Reference	Driver's full name.

Rallynuts Motorsport Tour of Epynt 2019 - Internet Entry Form

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