DST Leconfield Stages Rally 2022 - Internet Entry Form

Document Addressing

E-mail address for communication (It is your responsibility to supply a functioning email address - if you fail to do this we cannot be held responsible for failing to send you the link to download your passes and other necessary information) 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 This must be filled in to continue

Post Code

Home Town

Contact Telephone Number This must be filled in to continue

Competition Licence Number This must be filled in to continue

E-Mail Address (Please check it is correct) 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

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'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

Home Town

Contact Telephone Number This must be filled in to continue

Competition Licence Number This must be filled in to continue

E-Mail Address (Please check it is correct) 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

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'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 You cannot sign on until this is filled in

Engine Capacity

Forced Induction

No

Yes

Four Wheel Drive

No

Yes

Class You cannot sign on until this is filled in

0 - Class 0 - Cars up to and including 1000cc

1 - Class 1 - Cars up to and including 1400cc

2 - Class 2 - Cars between 1400cc and 1600cc

3 - Class 3 - cars between 1600cc and 2000cc

4 - Class 4 - 2WD Cars over 2000cc

5 - Class 5 - 4WD Cars over 2000cc

Turbo Tag Number (If applicable)

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

Vehicle 1

Make

Model

Colour

Registration Number

Driver Name & Passengers

Vehicle 2

Make

Model

Colour

Registration Number

Driver Name & Passenegers

Vehicle 3

Make

Model

Colour

Registration Number

Driver Name & Passengers

Vehicle 4

Make

Model

Colour

Registration Number

Driver Name & Passengers

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

CMSC Back to Roots Tarmack Championship

MINI Rally Challenge 2022

British Army Rally Championship

ANWCC Rally Championship

CMSC Back to Roots Tarmack Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

MINI rally Challenge 2022

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

British Army Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

ANWCC Rally 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

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

Class Position

Seeding - Competitor Opinion

Out of 100 entries, where do you think you should be seeded?

Scrutineering

When would you prefer to scrutineer?

Saturday: 14:00 - 18:00

Sunday: 06:30 - 08:30 (no starting of engines before 7:30)

Entry and other fees - See above for how to pay.

Entry Fee(s) - Select from Drop Down Menu (Bank Transfer on all items required)

£

Sheffield & Hallamshire Membership until 31/12/2022

£

Fee for camping overnight (Saturday)

£

Marshals fund

£

Air ambulance charity

£

Total Money to be sent

£

Entrant (if applicable and not driver)

Name

Address

Post Code

Telephone Number

Competition Licence Number

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.

No

Yes

We would like to offer you the option to receive photography proofs from our Officials photographer/Videographer - Kevin Money and Ian Maddison

If you are happy to allow us to do this, please say so here.

No

Yes

The event is not currently open for entries

Bank	Yorkshire Bank
Sort Code	05-08-18
Account No.	33223113
Account Name	Sheffield & Hallamshire Motor Club Ltd
Reference	Driver's First name and Surname

DST Leconfield Stages Rally 2022 - Internet Entry Form

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