GREAT BUSTARD RALLY 2012 ENTRY FORM
Held under the General Regulations of the Motor Sports Association (incorporating the provisions of the International sporting code)
ENTRANT DETAILS (optional):
Name:		Comp. licence No.:
Address:		Club:
Town:
County:		Postcode:
DRIVER DETAILS:
First name:		Last name:
Address:		Comp. licence No.:
		Champ. No.:
Town:		Club:
County:		Postcode:
Email:		Telephone:
NAVIGATOR DETAILS:
First name:		Last name:
Address:		Comp. licence No.:
		Champ. No.:
Town:		Club:
County:		Postcode:
Email:		Telephone:
VEHICLE DETAILS:
Make:		Model:
Year:		CC:
Colour:		Registration No.:
Class:	1. Experts in petrol cars 1301 – 1400cc 2. Experts in petrol cars 1001 - 1300cc 3. Experts in petrol cars up to 1000cc and diesel cars up to 2000cc 4. Semi-Experts in petrol cars 1301 – 1400cc 5. Semi-Experts in petrol cars 1001 - 1300cc 6. Semi-Experts in petrol cars up to 1000cc and diesel cars up to 2000cc 7. Novices in petrol cars up to 1400cc and diesel cars up to 2000cc 8. Clubmans rally expert/semi expert 9. Clubmans rally novices
Seeding information:
INSURANCE:
I wish to use REIS scheme on the event		YES NO
I require a declaration form		YES NO
I shall be arranging my own insurance:
Company		Policy No.:
Broker address:
PAYMENT:
Entry fee:	£225
Insurance fee:	£30
Membership fee:	£15/head
Breakfast:	£7/head
Donation to Air Ambulance:
Payment method:	BACS / BANK TRANSFER CHEQUE
	BACS details: Acoount No. Sort code
	Please make cheques payable to Salisbury & Shaftesbury Car Club Ltd. and send to.
	Chris Damper
	56 Pinehurst Rd.
	West Moors
	Dorset
	BH22 0AP
	Entries are not valid until the payment has been received. Please ensure that payment is made promptly.
Please note that clicking the submit button indicates acceptance of the following declarations. At signing on all persons will be required to sign the second page of the standard entry form HERE In the event of driver or navigator being under 18, their entry will need to be countersigned by a parent or guardian. If this person is not going to be present at signing on then please print a copy of the above entry form and arrange for it to be signed in advance. I declare that I have been given the opportunity to read the General Regulations of the Motor Sports Association and, if any, the Supplementary Regulations for this event and agree to be bound by them. I declare that I am physically and mentally fit to take part in the event and I am competent to do so. I acknowledge that I understand the nature and type of the competition and the potential risk inherent with motor sport and agree to accept that risk. I declare that the use of the vehicle hereby entered will be covered by insurance as required by the law which is valid for such part of this event as shall take place on roads as defined by the law.
If some details are unknown then please leave these sections blank and contact the secretary at a later date by telephone or email If Driver and navigator wish to submit details separately then Please submit 2 forms and fill in the others name so the 2 forms can be linked together