STATION GARAGE MITSUBISHI

GRANITE CITY RALLY

 April 26 th 2008

  1. Please complete all fields
  2. Click on the Submit Button, and the form will be emailed to the Entries Secretary on granite@admc.org.uk
  3. Print off and sign the form, and send with a cheque for the full amount, including Insurance to:Rae Osborne, Sunnyside of Gight,Methlick Ellon Aberdeenshire, AB41 7JD
  4. To Print the form click on File, (on the left at top of this page). Select print. (problems? tel: 01651 806862
  5. Your Entry will be acknowledged, by email upon receipt of the hard copy, accompanied by a cheque for the Entry Fee, Insurance, and Management Pack if required

The information entered on this form will be stored in a computer and used to produce a list of entries.The Organisers intend to pass your contact details to the event Official Photographer, if you do not wish your details to be passed on please tick

INDEMNITIES All relevant indemnities will be included at signing on for competitors to sign as per MSA General Regulation B9.6

COMPETITORS SIGNATURES

Driver   Co-Driver   Entrant  

If an Entrant, Driver or Co-Driver is under 18 years of age, this form must be countersigned by an appropriate parent or guardian,who has read and acknowledged the indemnity MSA General regulation B9.4.1, as per MSA General Regulation B9.3.8

THIS ENTRY IS MADE WITH MY CONSENT

Parent or Guardian of Entrant / Driver/ Co-driver (Delete as applicable)

Full Name of Parent or Guardian

Address

 

Signature

 

 

(block capitals please)

Tel No

 

REMITTANCES (Cheques Payable to 'ADMC Ltd') (delete amounts if not applicable, and adjust Total)

Rally Entry Fee
£460.00
Lockton Insurance
£26:00
Management Pack
£25:00
Total
  

INSURANCE Please read Article 20 in Supplementary Regulations BEFORE completing this section

Will you require Lockton Motor Sport Club Scheme - Rally Insurance?

(if YES remittance MUST be included with the Entry Fee)

If using your own insurance, please state: (Not Brokers name; state insurance Company and address)

Name of Company Policy No

Address

 

(OFFICE USE ONLY)

Ref No

Received

Acknowledged

Class

Seeding

Comp No

Please send all correspondence to (Please click ONE only)
If no box is ticked Default Address is DRIVER. Acknowledgement will be by email.

Entrant(if different from Driver)

Name Tel

Address

Entrants Licence No

No Entry will be credited to a Trade Entrant unless the Licence Number is quoted here and produced at Signing On

Driver

Competition Licence No Club

First Name Last Name

Tel Day Tel Home

Address

Town Postcode Email address

Championships

County SAAB Scottish Rally Championship Ecosse 205 Four Event

Next of Kin

Name Tel No

Address

Co-Driver

 Competition Licence No Club

First Name Last Name

Tel Day Tel Home

Address

Town Postcode Email address

Championships

 County SAAB Scottish Rally Championship Ecosse 205

Co-DriverNext of Kin

Name Tel No

Address

Car

Make Model Reg No

Capacity Turbo 4W/D 8 Valve 16 Valve

Class Entered Colour

Seeding Information

Enter below details of best 5 results achieved by the Driver since 1st January 2004 on stage rallies. This information will be checked and will be used as the main source of information for seeding. Incomplete information may result in an inappropriate start number. Additional information may be submitted by email granite@admc.org.uk

Event Name Status Year Class Position Overall Position Comments

FORM COMPLETE? Click on the Submit Button, and the form will be emailed to the Entries Secretary on granite@admc.org.uk