Coppermines Grizedale Stages Rally 2024

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

Post Code

Mobile Number This must be filled in to continue

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

Issuing Authority : MS-UK (Motorsport UK) / Other (state)

E-Mail Address

Club 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) Competitors under 18 yrs old must submit to the entries secretary a hard copy of the entry form, signed by their parent or guardian, before the event.

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

Post Code

Telephone Number

Mobile Number This must be filled in to continue

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

Issuing Authority: MS-UK (Motorsport UK) / Other (state)

E-Mail Address

Club You cannot sign on until this is filled in

Club Membership No

Date of Birth (if under 18) Competitors under 18 yrs old must submit to the entries secretary a hard copy of the entry form, signed by their parent or guardian, before the event.

Co-Driver's Parent or Guardian (under 18 only)

Name

Address (if different)

Post Code

Telephone Number

Relationship

Car

Make This must be filled in to continue

Model This must be filled in to continue

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 This must be filled in to continue

1 - R5's, Rally 2's etc (see SR 9.1)

2 - Non-R5/Rally 2 4WD's and cars over 2000cc (see SR 9.1)

3 - Cars 1601cc to 2000cc (see SR 9.1)

4 - Cars 1401cc to 1600cc (see SR 9.1)

5 - Cars up to 1400cc (see SR 9.1)

H1 - Historic cars up to 31/12/74 (see SR 9.1)

H2 - Historic cars 1/1/75 to 31/12/81 (see SR 9.1)

H3 - Historic cars 1/1/82 to 31/12/90 (see SR 9.1)

In Car Camera Request

Insurers - please include details of your insurers unless you are using the event road section insurance (see section below)

Name

Address

If you wish to use the REIS road section insurance, can you comply with the Insurance Declaration quoted in the regulations SR 11.6? 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

Service Vehicle

Make

Model

Registration Number

Sponsor/s

Sponsor Name (Note: this sponsor does not need an entrant's licence)

Championships

SG Petch ANECCC Stage Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

REIS Motorsport UK English Rally Championship

Crew Members Registered

None

Driver

Co-Driver

Both

Driver Championship Registration Number

Co-Driver Championship Registration Number

Proflex Shock Absorbers ANCC Stage 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 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

Event Name

Year

Surface

Overall Position

No of Starters

Seeding - Competitor Opinion

Out of 80 entries, where do you think you should be seeded? You cannot sign on until this is filled in

Fees - see top of entry form for how to pay.

Entry Fee - use dropdown for appropriate fee This must be filled in to continue

£

Club Membership

£

Insurance

£

Additional Support Vehicles

£

Total Money to be sent

£

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

The event is not currently open for entries

Bank	NatWest
Sort Code	01-04-66
Account No.	80164420
Account Name	Grizedale Stages Rally
Reference	Driver's full name.

Coppermines Grizedale Stages Rally 2024 - Internet Entry Form

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