THE TILEMASTER ADHESIVES Lee Holland Memorial Rally 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 final instructions and entry tickets to? This must be filled in to continue

Driver

Co-Driver

Driver

Full Name This must be filled in to continue

Address This must be filled in to continue

Post Code This must be filled in to continue

Home Town You cannot sign on until this is filled in

Telephone Number This must be filled in to continue

Mobile Number This must be filled in to continue

Competition Licence Number This must be filled in to continue

Competition Licence Issuer

E-Mail Address This must be filled in to continue

Club(If no club is entered in here it is assumed you will require membership of PDMC or GPMC) You cannot sign on until this is filled in

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

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 This must be filled in to continue

Post Code This must be filled in to continue

Home Town This must be filled in to continue

Telephone Number This must be filled in to continue

Mobile Number This must be filled in to continue

Competition Licence Number This must be filled in to continue

Competition Licence Issuer

E-Mail Address This must be filled in to continue

Club (If no club is entered in here it is assumed you will require membership of PDMC or GPMC) 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 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 You cannot sign on until this is filled in

Registration Number You cannot sign on until this is filled in

Engine Capacity You cannot sign on until this is filled in

Year

Forced Induction / Rotary

No

Yes

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

No

Yes

Class This must be filled in to continue

A - Cars up to and including 1400cc

B - Cars 1401cc up-to and including 1600cc

C - Cars 1601cc up to and including 2000cc

D1 - Cars of 2001cc and over 2WD

D2 - Cars of 2001cc and over 4WD

E - All MAZDA MX5 cars 1601- 1800

F - Cars upto 1000cc

R - Road Rally Cars (complying with R.18 of the current Blue book & must have a stage rally passport / log book)

In Car Camera Request You cannot sign on until this is filled in

No in car camera

MAD Video camera

Own in car camera

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

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

Motorsport News Circuit Rally Championship Competitor

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

MSN Rally Champ - Michelin Cup Competitor

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

MSN Rally Champ - Protyre Challenge Competitor

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

ANWCC Stage Rally Championsip Competitor

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

SD34 MSG Stage Rally Championship Competitor

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 This must be filled in to continue

Address

Post Code

Telephone Number This must be filled in to continue

Relationship

Will this person be attending the event?

Person to be contacted in case of serious accident to Co-Driver

Name This must be filled in to continue

Address

Post Code

Telephone Number This must be filled in to continue

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 80 entries, where do you think you should be seeded?

Please use an exact number not a range. This must be filled in to continue

Scrutineering

Saturday scrutineering is as the Final Instructions

Sunday morning scrutineering is STRICTLY by appointment and must be requested in writing to the entries secretary This must be filled in to continue

Saturday

Sunday (By written appointment only places limited)

Fees - see above for how to pay

Entry Fee

£

Club Membership (Please Select)

£

Garage (allocated on first come first served basis - max 20 (single car units, available) + 5 reserves)

ALL GARAGES ARE HIRED OUT

£

Total Money to be sent

£

Payment Method and Details

Bank Transfer (Ref Drivers Full Name)

Cheque (Please quote on rear Drivers Full Name)

Cash

Entrant (if applicable and not driver)

Name

Address

Post Code

Telephone Number

Nationality

Competition Licence Number

Competition Licence Issuer

Club Membership No

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

We would also like to be allowed to pass on your Name, Address, Post Code and email addresses to [MAD VIDEO] and [DUNCAN LITTLER / STEVE McKENNA ] so that they can contact you with a view to offering you videos and photos of you on the event. If you are happy to allow us to do this, please say so here.

Yes

No

The event is not currently open for entries

Bank	Lloyds TSB
Sort Code	77-76-05
Account No.	46829260
Account Name	LEE HOLLAND RALLY
Reference	Drivers Full Name (Failure to provide this will delay your application)

THE TILEMASTER ADHESIVES Lee Holland Memorial Rally 2019 - Internet Entry Form

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

PLEASE NOTE WE ARE NOT ACCEPTING PAYPAL PAYMENTS ON THIS EVENT