Southern Car Club - KSport Tarmac Stages

The "K-Sport" tarmac Stages Rally ENTRY FORM

Sunday 15th August 1999

Please complete in block capitals.

DRIVER

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

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

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

Licence No. ........................ Club....................................................................................

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

CO-DRIVER

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

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

..............................................................................................................................

Licence No. ........................ Club....................................................................................

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

ASEMC Championship Driver Yes/No Co-Driver Yes/No

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

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

Capacity...……....…. Valves per cylinder ................... 2WD/4WD ………………………

Forced Induction Yes/No

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

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 £157.00 to:

Sue Smith, 126 Cardinal Avenue, Morden, Surrey SM4 4SX

BEFORE THE CLOSING DATE OF SATURDAY 2nd AUGUST 1999

Now PLEASE COMPLETE THE INDEMNITY ON THE REVERSE OF THIS FORM.