GEG Promenade 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 This must be filled in to continue

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

Licence Grade

Rally National B Stage

Rally National A Stage

Rally International

E-Mail Address This must be filled in to continue

Club You cannot sign on until this is filled in

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

Gender You cannot sign on until this is filled in

Female

Male

Novice You cannot sign on until this is filled in

No

Yes

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

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

Licence Grade

Rally National B Stage

Non-Race National B

Rally National A Stage

Rally National A Navigator

Rally International

E-Mail Address This must be filled in to continue

Club You cannot sign on until this is filled in

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

Gender You cannot sign on until this is filled in

Female

Male

Novice You cannot sign on until this is filled in

No

Yes

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 1400cc

2 - 1401cc - 1600cc

3 - 1601cc - 2000cc

4 - over 2000cc

In Car Camera Request

No

Yes

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

#1 Additional Car/Motorhome/Caravan in Service Area

Make

Model

Colour

Registration Number

#2 Additional Car/Motorhome/Caravan in Service Area

Make

Model

Colour

Registration Number

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

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Association of North Western Car Clubs Championships 2019

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

SD(34) Motorsport Group Championships 2019

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Yokohama Tyres Senior F1000 Championship 2019

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?

Seeding - Past Performance on Stage Rallies by Driver Only
We can only seed you on the information you supply - please give as much detail as possible.

Event Name and Club

Year

Type

Surface

Overall Position

Class position

Seeding - Competitor Opinion

Out of 95 entries, where do you think you should be seeded?

Fees - see above for how to pay

Entry Fee

£

Club Membership

£

Marshal Fund

£

1 Extra Vehicle £20

£

2 Extra Vehicles £40

£

Total Money to be sent

£

Payment Method and Details This must be filled in to continue

Bank Transfer

Cheque (payable to Wallasey Motor Club)

Stripe

Entrant (if applicable and not driver)

Name

Address

Post Code

Telephone Number

Competition Licence Number

Club Membership No

Programme / Web Site

Please give information on you & your car for possible use in any pre-event publicity & the event programme

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 Rally Gallery and Mad Video 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

GEG Promenade Stages Rally 2019 - Internet Entry Form

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

Seeding - Past Performance on Stage Rallies by Driver Only We can only seed you on the information you supply - please give as much detail as possible.

Seeding - Past Performance on Stage Rallies by Driver Only
We can only seed you on the information you supply - please give as much detail as possible.