Entry Form

Driver Details

Driver Contact, In case of emergency:

Driver Championships

Co-Driver

Co-Driver Contact, In case of emergency:

Co-Driver Championships

Vehicle Details

Engine

Sponsor details (if applicable)

Recent Stage Results

***Only drivers results will be accepted for seeding purpose.***

Failure to provide seeding information will result in your start number being allocated by the Organising Team. NO discussions regarding this will be entertained by the organisers.
Event 1
Event 2
Event 3
Event 4

Permission

Confirmation

BACS Transfer


BACS transfers of £215.00 can be made to: -
Lloyds Bank. Sort Code:- 30 17 48
Account number:- 00145819

Account Name:- Wigan & District Motor Club (Rally Account).

Please use driver or co-driver's name as a reference.