Hills Ford Three Shires Stages 2021

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

How would you like to receive Finals and Results?

Email

Website

Driver

Full Name This must be filled in to continue

Address

Post Code

Home Town

Telephone Number

Mobile Number

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

E-Mail Address

Club - See Article 5 (Competitor Eligibility) in the regs. 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).

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 (per K10.3.1) 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 (per K10.3.1) You cannot sign on until this is filled in

Driver Publicity

Hobbies

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

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

E-Mail Address

Club - See Article 5 (Competitor Eligibility) in the regs. 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).

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 (per K10.3.1) 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 (per K10.3.1) You cannot sign on until this is filled in

Co-Driver Publicity

Hobbies

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 You cannot sign on until this is filled in

Year

Forced Induction

No

Yes

Class You cannot sign on until this is filled in

A - Cars up to and including 1400cc

B - Cars from 1401cc to 1600cc

C - Cars from 1601cc to 2000cc

D - Cars over 2000cc

E - 4 Wheel Drive Cars that do not qualify for F

F - Current and former World Rally cars with a sequential gearbox, plus current and former S2000, RRC and R5 cars and any derivatives

H - Historic (Cat 1, Cat 2, Cat 3. and Cat 4)

In Car Camera Request

Yes

No

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

Insurers

Name

Address

First Service Crew

Contact Name

Contact Number

Second Service Crew

Contact Name

Contact Number

Third Service Crew

Contact Name

Contact Number

Fourth Service Crew

Contact Name

Contact Number

Fifth Service Crew

Contact Name

Contact Number

Recce Vehicle

Make

Model

Colour

Registration Number

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

Protyre Motorsport UK Asphalt Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Fuchs Lubricants Motorsport UK British Historic Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Fuchs Lubricants RACRMC Asphalt/Rally2 Mixed Surface Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Crew 25 Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Lions Cup Championship

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 You cannot sign on until this is filled in

Address

Post Code

Telephone Number You cannot sign on until this is filled in

Relationship

Will this person be attending the event?

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

Name You cannot sign on until this is filled in

Address

Post Code

Telephone Number You cannot sign on until this is filled in

Relationship

Will this person be attending the event?

Seeding - Past Performance on Rallies - Please Note: Drivers must have completed at least THREE Interclub (previously known as National B) Stage Rallies. (As per SR7.2)

Event Name and Club

Year

Type

Surface

Overall Position

No of Starters

Seeding - Competitor Opinion

Out of 140 entries, where do you think you should be seeded?

Recce

Would you like to take part in the recce?

Yes

No

Would you prefer to service indoors or outdoors? (Indoors subject to availability, occupants will be chosen at random)

Indoors

Outdoors

Fees - Payable by BACS, Cheque or Cash. Details at top of form.

Entry Fee

£

Club Membership

£

Insurance

£

Total Money to be sent

£

Payment Method and Details This must be filled in to continue

BACS

Stripe

Cheque (I will post a cheque to the entries secretary)

Entrant (if applicable and not driver)

Name

Address

Post Code

Telephone Number

Nationality

Competition Licence Number

Competition Licence Issuer

Club Membership No

Comments

Any relevant 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.

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

Yes

We would also like to be allowed to pass on your Name, Address, Post Code and email addresses to Special Stage TV and M&H Photography 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.

No

Yes

The event is not currently open for entries

Hills Ford Three Shires Stages 2021 - Internet Entry Form

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