East Riding Stages Rally 2024 - 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 You cannot sign on until this is filled in

Post Code You cannot sign on until this is filled in

Mobile Number You cannot sign on until this is filled in

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

E-Mail Address You cannot sign on until this is filled in

Club You cannot sign on until this is filled in

Date of Birth if under 18

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

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 This must be filled in to continue

Address You cannot sign on until this is filled in

Post Code You cannot sign on until this is filled in

Mobile Number You cannot sign on until this is filled in

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

E-Mail Address You cannot sign on until this is filled in

Club You cannot sign on until this is filled in

Date of Birth (if under 18)

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

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

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 You cannot sign on until this is filled in

Year

Forced Induction

No

Yes

Four Wheel Drive

No

Yes

Class You cannot sign on until this is filled in

A - Less than 1400cc 2-wheel drive

B - Less than 1600cc 2-wheel drive

C - Less than 2000cc 2-wheel drive

D - 2000cc and over 2-wheel drive

E - All 4-wheel drive cars

H - All historic cars (as defined by R.49)

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

Insurance

If you require cover under the Marsh 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

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

First Service Crew (by 25th January latest)

Contact Name

Contact Number

Second Service Crew (by 25th January latest)

Contact Name

Contact Number

Third Service Crew (by 25th January latest)

Contact Name

Contact Number

Fourth Service Crew (by 25th January latest)

Contact Name

Contact Number

Fifth Service Crew (by 25th January latest)

Contact Name

Contact Number

Service Vehicle (by 25th January latest)

Make

Model

Colour

Registration Number

Recce Vehicle (by 25th January latest)

Make

Model

Colour

Registration Number

Additional Vehicle Pass into Service (by 25th January latest)

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

Proflex Shock Absorbers ANCC Stage Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

AS Performance North of England Tarmacadam Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

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 You cannot sign on until this is filled in

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 You cannot sign on until this is filled in

Will this person be attending the event?

Seeding - Past Performance on Rallies - if you don't fill this in you'll end up at the back of the field

Event Name and Club

Year

Type

Surface

Overall Position

No of Starters

Seeding - Competitor Opinion

Out of 150 entries, where do you think you should be seeded?

Scrutineering

What time would you prefer to scrutineer? If no time is marked, any free time slot will be allocated

12:00 - 13:00

13:00 - 14:00

14:00 - 15:00

15:00 - 16:00

16:00 - 17:00

How do you intend to refuel?

Vital Equipment

Self Refuel Area

Filling Station on road section

Fees - see above for how to pay

Entry Fee

£

Club Membership

£

Insurance

£

Optional Donation to the Marshals Fund

£

Tracker for Recce vehicle and Rally Car

£

Total Money to be sent

£

Entrant (if applicable and not driver) - Any entrant given without a licence number will be removed

Name

Address

Post Code

Competition Licence Number

Comments

Anything else you'd like to tell us

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, which is rallies.info.You can find out how Beverley & District Motor Club processes your information by reading our privacy policy, and you can also see how rallies.info process your information on their privacy policy

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 the official photographer and videographer 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.

Yes

No

The event is not currently open for entries

East Riding Stages Rally 2024 - Internet Entry Form

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