Document Addressing E-Mail address for communication
Real Name of this person
Whom should we e mail information to? Driver Co-DriverAre a printed set of results required?
E-mail/Website Posted PaperDriver Full Name
Address Post Code
Home Town
Telephone Number
Mobile Number
Competition Licence Number
Competition Licence Issuer
E-Mail Address
Club
Date of Birth
Nationality
Driver Publicity 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
Co-Driver Full Name
Address Post Code
Home Town
Telephone Number
Mobile Number
Competition Licence Number
Competition Licence Issuer
E-Mail Address
Club
Date of Birth
Nationality
Co-Driver Publicity 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
Car Details Make
Model
Colour
Registration Number
Engine Capacity
Year
Class N3 - Current and former FIA Group N cars over 1400cc up to and including 2000cc NR4 - Current and former FIA Group N cars over 2000cc R2 - All FIA R2 (B) cars B10 - Over 1400cc up to and including 1600cc B11 - Over 1600cc up to and including 2000cc B12 - Over 2000cc two wheel drive, including all FIA R3T cars B13 - Over 2000cc four wheel drive cars that do not qualify for Class NR4 or B14 and FIA R4 cars B14 - Current and former World Rally Cars with a sequential gearbox, plus current and former S2000 and R5 cars and any derivatives therefrom. H1/H2 - All Historic Category 1 and 2 cars and Category 3 and 3 cars with single cam engines H3 - Historic Category 3 cars with multi cam engines over 1600cc and plus all Category 4a cars and Category 4b cars up to 1600cc. H4 - Historic Category 4b cars over 1600cc which comply with R49.1.5 1400C - - Cars up to 1400cc with:- (a) 8 valve engines (b) Engines with more than 8 valves that retain the standard fuel and inlet manifold systems (c) Engines up to 1000cc not eligible for the BTRDA RF1.0 class(d) Current and former FIA Gp N1 cars. 1400S - All other cars up to and including 1400cc. RF1.4 - BTRDA Rally First cars over 1000cc up to and including 1400cc RF2.0 - BTRDA Rally First cars over 1400cc up to and includingg 2000ccFIA Homologation Number
Insurance
If you require cover under the REIS Road Traffic Act Insurance Scheme payment must be included with your entry.
If you are arranging your own Road Traffic cover, please provide details below.Name
Address Service vehicle 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 BTRDA Gold Star Championship Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number
Co-Driver Championship Registration Number
BTRDA Silver Star Championship Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number
Co-Driver Championship Registration Number
BTRDA Bronze Star Championship Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number
Co-Driver Championship Registration Number
BTRDA Production Cup Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number
Co-Driver Championship Registration Number
BTRDA Rallye R2 Cup Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number
Co-Driver Championship Registration Number
BTRDA 1400 Championship Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number
Co-Driver Championship Registration Number
BTRDA Rally First Championship Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number
Co-Driver Championship Registration Number
MRF ST Trophy Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number
Co-Driver Championship Registration Number
BTRDA Historic Cup Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number
Co-Driver Championship Registration Number
The 2019 Maxxis Tyres Motorsport UK English Championship Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number
Co-Driver Championship Registration Number
The ANCC Stage Rally Championship 2019 Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number
Co-Driver Championship Registration Number
The ANWWC Forest Rally Championship 2019 Crew Members Registered None Driver Co-Driver BothDriver Championship Registration Number
Co-Driver Championship Registration Number
The S G Petch Stage Rally Championship 2019 Crew Members Registered None Driver Co-Driver BothDriver 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 Rallies Scrutineering What time would you prefer to scrutineer? (TICK ONE ONLY) If no time is marked, ANY free time slot will be allocated
13:00 - 14:00 14:00 - 15:00 15.00 - 16.00 16.00 - 17.00 17.00 - 18.00 18.00 - 19.00 19.00 - 20.00 20.00 - 20.30Fees - see above for how to pay Entry Fee £625.00 - All classes EXCLUDING BTRDA Rally First Championship (RF1.4, RF2.0) 575.00 - BTRDA Rally First Championship (RF1.4, RF2.0) ONLY Club Membership £0.00 - Trackrod Motor Club Ltd - Not required 10.00 - Trackrod Motor Club Ltd (until the end of the year) 20.00 - Trackrod Motor Club Ltd (until the end of the year) x 2 Insurance £0.00 - Using Own Insurance Cover 20.00 - REIS Insurance Cover Larger service bay plate £0.00 - Larger space service plate - Not required 50.00 - Larger space service plate Parking permit for adjacent car park £0.00 - Permit for parking adjacent to service area - Not required 10.00 - Permit for parking adjacent to service area 20.00 - Permit for parking adjacent to service area x 2 Guest Pack £0.00 - Guest pack - not required 50.00 - Guest pack 100.00 - Guest pack x 2 Support the marshals £7.50 - Support the marshals - 1 sticker 15.00 - Support the marshals - 2 stickers 22.50 - Support the marshals - 3 stickers 0.00 - Support the marshals - Not required Total Money to be sent £ Please state payment method 1. Stripe (for card payments). 2. Cheque. 3. Bank Transfer
Entrant (if applicable and not driver) No entry will be credited to an Entrant unless the Licence Number is quoted here. This licence MUST be produced at signing on. Name
Address Post Code
Telephone Number
Nationality
Competition Licence Number
Competition Licence Issuer
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.
No YesWe would also like to be allowed to pass on your Name, Address, Post Code and email addresses to Tom Irvin Photography so that they can contact you with a view to offering you photographs of you on the event. If you are happy to allow us to do this, please say so here.
No Yes