NHMC Cadwell 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

Whom should we send Finals and Results to?

Driver

Co-Driver

How would you like to receive Finals and Results?

E-mail/Website

Posted Paper

Driver

Full Name This must be filled in to continue

Address

Post Code

Home Town

Telephone Number

Mobile Number

Motorsport UK 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 (If under 18)

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

Post Code

Home Town

Telephone Number

Mobile Number

Motorsport UK 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 (If under 18)

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 or Rotary engine

No

Yes

Four Wheel Drive

No

Yes

Class You cannot sign on until this is filled in

A1 - All 2 wheel drive cars up to and including 1000 cc

A2 - All 2 wheel drive cars 1001 cc up to and including 1400 cc

B - All 2 wheel drive cars 1401 cc up to and including 1600 cc

C - All 2 wheel drive cars 1601 cc up to and including 2000 cc

MX5 - All Mazda MX5’s between 1601 cc and 1800 cc

D1 - All 2 wheel drive cars of over 2001 cc and up to 3000 cc

D2 - All 4 wheel drive cars

GT - GT cars in line with Motorsport UK regulation R46.4 or FIA R/GT regulations

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.

Eligibility for Championships and Awards

The Motorsport News Circuit Rally Championship in association with MSVR featuring the Michelin Cup and the Protyre Challenge

Crew Members Registered

None

Driver

Co-Driver

Both

MSN Rally Championship Michelin Cup

Crew Members Registered

None

Driver

Co-Driver

Both

MSN Rally Championship Protyre Challenge

Crew Members Registered

None

Driver

Co-Driver

Both

Wemix Concrete Ltd EMAMC Stage Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

The ANWCC Stage Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

North Humberside Motor Club Crew award (see SR 12 for eligability)

Crew Members Registered

No

Yes

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

Position in Class

Seeding - Competitor Opinion

Out of 90 entries, where do you think you should be seeded?

Scrutineering

When would you prefer to scrutineer? (If neither box is ticked, Saturday will be assumed.)

Saturday 16th November - 14:00 to 18:00

Sunday 17th November - 06:00 to 08:00

Fees - see above for how to pay

Entry Fee

£

Club Membership

£

Donation to the Marshals Fund

£

Total Money to be sent

£

Payment Method and Details: Scheme A (1 cheque) or B (1 direct transfer) - see above This must be filled in to continue

Scheme A (1 cheque)

Scheme B (1 direct bank transfer)

Entrant (if applicable and not driver)

Name

Address

Post Code

Telephone Number

Nationality

Motorsport UK Competition Licence Number

Club Membership No

Marshal Details - if you know of a marshal who'd like to come and help, please give details here

Name

Address

Post Code

Telephone Number

Mobile Number

Email Address

Experience

Comments

Anything else you'd like to tell us

Privacy and Permissions

We take your privacy seriously and shall 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 should 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 should also like to be allowed to pass on your Name, Address, Post Code and email addresses to Mad Video (the event's official video team), Kevin Money (the event's official photographer), Torque (MN/MSVR Championship video team) and SMJ Photography (MN/MSVR Championship photographer) 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

NHMC Cadwell Stages Rally 2019 - Internet Entry Form

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