Wigan & District Motor Club

Entry Form

Event: The Cetus Stages, Three Sisters Race Circuit, Wigan on Sunday 14th May 2017

Closing Date: Friday 12th May 2017

It is the responsibility of the entrant to complete all sections of this form. The Secretary of the Meeting has the right to refuse any incomplete or incorrect entry. The entrant is responsible for sending this form with the appropriate entry fee to the Entry Secretary, who will acknowledge your entry by E mail. Final Instructions, Entry list and results will only be published on the Motor Club web site:- www.wiganmotorclub.org.uk

Driver

Basic Details

(Relevant clubs only please)
Yes
No

Next of Kin

Driver's Championships

ANCC Stage Rally Championship
ANWCC Stage Rally Championship
ANWCC Ladies Stage Rally Championship
6R4.com Three Sisters Rally Challenge
SD34 MSG Inter Club League
SD34 MSG Stage Rally Championship

Co-Driver

Basic Details

(Relevant clubs only please)
Yes
No

Next of Kin

Co-Driver's Championships

ANCC Stage Rally Championship
ANWCC Stage Rally Championship
ANWCC Ladies Stage Rally Championship
6R4.com Three Sisters Rally Challenge
SD34 MSG Inter Club League
SD34 MSG Stage Rally Championship

Vehicle Details

CC
Naturally Aspirated
Turbo
Supercharged
Rotary

Entrant Information (if applicable)

Recent Stage Results

Payment

The entry fee for this event is £165.00

Competitors entries will remain pending until full payment has been received & cleared by the bank.

Please select which payment method you will be using:

Cheque
Bank Transfer
Paypal

Cheque

Make cheques payable to, Wigan & District Motor Club Rally Account. Cheques should be sent to:

Helen Fox
41 Elgin Avenue
Ashton-in-Makerfield
Wigan
Lancs.
WN4 ORH.

BACS Transfer

BACS transfers 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.

Paypal

Payment via Paypal costs £171 in order to fully cover additional fees incurred by Paypal.

Payments can be made via Paypal to [email protected] .

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


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