STATION GARAGE MITSUBISHI

GRANITE CITY RALLY

 April 25th 2009

  1. Please type your details into the form
  2. Print off the completed form BEFORE Clicking the SUBMIT Button
  3. To Print the form click on File, (on the left at top of this page). Select print. Depending upon your operating system i.e Vista, XP, Windows 2000, it may print over several pages. Don't worry as the printed form helps to match up your cheque with your entry. (problems? tel: 01651 806862
  4. Click on the Submit Button, and the form will be written to a database.
  5. Send the printed form with a cheque for the full amount, including Insurance to:Rae Osborne, Sunnyside of Gight,Methlick Ellon Aberdeenshire, AB41 7JD
  6. 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

If an Entrant, Driver or Co-Driver is under 18 years of age, the Signing on 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

Rally Entry Fee
£450.00
Lockton Insurance
£26:00
Management Pack
£25:00
Total
  

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

Comp Lic No Club

First Name Last Name

Tel Day Tel Home

Address

Town Postcode Email

Championships

Hankook Scottish Rally Championship Ecosse 205 Four Event

Next of Kin

Name Tel No

Address

Co-Driver

 Comp Lic No Club

First Name Last Name

Tel Day Tel Home

Address

Town Postcode Email

Championships

 Hankook 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? Print off the form. Click on the Submit Button, and your entry will be entered into the event database