Lee Holland Memorial Rally 2023 - 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 final instructions and entry tickets to? This must be filled in to continue

Driver

Co-Driver

Driver

Full Name This must be filled in to continue

Address This must be filled in to continue

Post Code This must be filled in to continue

Home Town You cannot sign on until this is filled in

Telephone Number This must be filled in to continue

Mobile Number This must be filled in to continue

Competition Licence Number This must be filled in to continue

Competition Licence Issuer

E-Mail Address This must be filled in to continue

Club(If no club is entered in here it is assumed you will require membership of PDMC or GPMC) You cannot sign on until this is filled in

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

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 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 This must be filled in to continue

Post Code This must be filled in to continue

Home Town This must be filled in to continue

Telephone Number This must be filled in to continue

Mobile Number This must be filled in to continue

Competition Licence Number This must be filled in to continue

Competition Licence Issuer

E-Mail Address This must be filled in to continue

Club (If no club is entered in here it is assumed you will require membership of PDMC or GPMC) 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 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 You cannot sign on until this is filled in

Registration Number You cannot sign on until this is filled in

Engine Capacity You cannot sign on until this is filled in

Year

Forced Induction / Rotary

No

Yes

Four Wheel Drive You cannot sign on until this is filled in

No

Yes

Class This must be filled in to continue

A - Cars with engines up to 1400cc

B - Cars with engines from 1401cc up to and including 1600cc

C - Cars with engines from 1601cc up to and including 2000cc plus cars with forced induction under 1300cc

D - Two Wheel Drive Cars with engines over 2000cc

E - All Four Wheel Drive Cars

F - Cars up to and including 1000cc

R - Road rally cars (Complying with R18 of current Blue Book & must have a stage rally passport / logbook

J - Junior Formula 1000 cars

In Car Camera Request

No in car camera

Own in car camera

Novice Crew

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

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

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

MGJ Circuit Rally Championship Competitor

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

ANWCC Stage Rally Championsip Competitor

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

SD34 MSG Stage Rally Championship Competitor

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Junior F1000 Rally Championship Competitor

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 This must be filled in to continue

Address

Post Code

Telephone Number This must be filled in to continue

Relationship

Will this person be attending the event?

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

Name This must be filled in to continue

Address

Post Code

Telephone Number This must be filled in to continue

Relationship

Will this person be attending the event?

Seeding - Past Performance on Rallies

Event Name and Club

Year

Type

Surface

Overall Position

No of Starters

Seeding - Competitor Opinion

Out of 60 Senior entries or 20 Junior entries where do you think you should be seeded?

Scrutineering

When would you prefer to scrutineer?

Saturday Scrutineering

Sunday Scrutineering

Fees - see above for how to pay

Entry Fee This must be filled in to continue

£

Club Membership (Please Select)

£

Insurance

£

Donation to marshal fund

£

Garages ( See SR's Article 21)

£

Total Money to be sent

£

Payment Method and Details

Bank Transfer (Ref Drivers Full Name)

Entrant (if applicable and not driver)

Name

Address

Post Code

Telephone Number

Nationality

Competition Licence Number

Competition Licence Issuer

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 also like to be allowed to pass on your Name, Address, Post Code and email addresses to the event official media partners 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

Lee Holland Memorial Rally 2023 - Internet Entry Form

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

PLEASE NOTE WE ARE ONLY ACCEPTING BACS PAYMENTS ON THIS EVENT