Rali Mike Darowen Bro Ddyfi 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

Driver

Full Name This must be filled in to continue

Address This must be filled in to continue

Post Code You cannot sign on until this is filled in

Mobile Number You cannot sign on until this is filled in

Telephone Number You cannot sign on until this is filled in

Competition Licence Number This must be filled in to continue

E-Mail Address This must be filled in to continue

Club You cannot sign on until this is filled in

Club Membership No

Date of Birth 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

Navigator

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

Mobile Number You cannot sign on until this is filled in

Telephone Number You cannot sign on until this is filled in

Competition Licence Number This must be filled in to continue

E-Mail Address

Club You cannot sign on until this is filled in

Club Membership No

Date of Birth You cannot sign on until this is filled in

Navigator's Parent or Guardian (under 18 only)

Name

Address (if different)

Post Code

Telephone Number

Relationship

Competition Licence Issuer

Car

Make This must be filled in to continue

Model This must be filled in to continue

Colour You cannot sign on until this is filled in

Registration Number This must be filled in to continue

Engine Capacity This must be filled in to continue

Class You cannot sign on until this is filled in

B - Beginners

N - Novice

M - Mentors

Insurers

Name

Are you using the event Insurance?

Name of Company if using own

Address

If you wish to use the road section insurance, can you comply with the Insurance Declaration quoted in the regulations? You cannot sign on until this is filled in

Yes - I wish to use the insurance and I comply with all points

No - I wish to use the insurance but do not comply (please contact me)

N/A - I have my own insurance

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 Navigator

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

Overall Position

No of Starters

Seeding - Competitor Opinion

Out of 60 entries, where do you think you should be seeded?

Fees

Entry Fee

£120

£

Club Membership

£20 per crew for this event only unless already registered

£

Insurance
Please ensure you refer to SR.22 before completing insurance

£

MSA License Application

£

Total Money to be sent

£

Payment Method and Details- BACS payment please put the driver name as the reference!

Bank account details are:

Dovey Valley MC Ltd

Nat West

Sort Code: 53-81-26

Account number: 3643 8413 This must be filled in to continue

Bank account

Marshal Details

Name This must be filled in to continue

Address

Post Code

Mobile Number You cannot sign on until this is filled in

Telephone Number

Email Address

Experience

Passage Control

Time Control

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 Duncan Littler 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

Rali Mike Darowen Bro Ddyfi 2023 - Internet Entry Form

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