The Poole Car Centre Stages in association with Racetec ENTRY FORM

Sunday 13th August 2000

Please complete in block capitals.

ENTRANT - NB: An Entrant will not be credited in the Entry List without a licence no.

Name ......................................................................................……………………………

Address ....................................................................................................................……..

................…..............................……………………………………………………….

Licence No. ......................…………………………

DRIVER

Name ......................................................................................………....…… Expert/Novice

Address ................................................................................................................………..

............................................................................................….................………..

Licence No. .....................…... Grade ………... Club...........................................................

Tel no. (h) ...........……....................................... Tel no. (w) .............................................….

CO-DRIVER

Name ......................................................................................………....…… Expert/Novice

Address .............................................................................................................................

............................................................................................….............................

Licence No. .....................…... Grade ………... Club............................................................

Tel no. (h) ...........……....................................... Tel no. (w) .............................................….

ACSMC/ASEMC Championship Driver Reg No: ………… Co-Driver Reg No: …………

ASWMC Championship Driver Reg No: ………… Co-Driver Reg No: …………

Class Entered: 1 2 3 4 5 (please circle)

Car Make and Model................................................................... Colour ........................

Capacity ...……....…. 2WD/4WD (please circle) Forced Induction: Yes/No

SEEDING INFORMATION (Enter Drivers last 5 results, as a driver, on stage rallies only)

Event

Date

Status

Organising Club

Pos.O/A

Class Pos

Seeding information may be checked. If details are found to be incorrect, competitors may be excluded. The organisers
will not enter into ANY arguments over seeding.

In the event of a serious accident, please provide name and telephone numbers of the person/s to be contacted.

DRIVER CO-DRIVER

Name …………....................................................………… Name...............................................................…………

Telephone .................................................………………….. Telephone .......................................................…………

Please send your completed entry form, enclosing a cheque payable to SOUTHERN CAR CLUB LTD to the value of £175.00 (plus any additional sponsorship donation) to: Ray Tyler, 101 Hightown Road, Ringwood, Hampshire BH24 1NL

BEFORE THE CLOSING DATE OF SATURDAY 5^th AUGUST 2000

Now PLEASE COMPLETE THE INDEMNITY ON THE REVERSE OF THIS FORM