Wigan & District Motor Club

Entry Form

Event: The Adgespeed Stages 2019, Three Sisters Race Circuit, Wigan on Sunday 13th October 2019

Entry Closing Date: Friday 11th October 2019

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

The ANWCC Stage Rally Championship 2019
The ANWCC Allrounders Championship 2019
The ANWCC Ladies Rally Championship 2019
The AWMMC Heart of England Stage Rally Championship 2019
6R4.com Three Sisters Rally Challenge 2019
The SD34MSG Interclub League 2019 (Supported by Gazard Accounts)
The SD34MSG Stage Rally Championship 2019 (Supported by Gazard Accounts)

Co-Driver

Basic Details

(Relevant clubs only please)
Yes
No

Next of Kin

Co-Driver's Championships

The ANWCC Stage Rally Championship 2019
The ANWCC Allrounders Championship 2019
The ANWCC Ladies Rally Championship 2019
The AWMMC Heart of England Stage Rally Championship 2019
6R4.com Three Sisters Rally Challenge 2019
The SD34MSG Interclub League 2019 (Supported by Gazard Accounts)
The SD34MSG Stage Rally Championship 2019 (Supported by Gazard Accounts)

Vehicle Details

CC
Naturally Aspirated
Turbo
Supercharged
Rotary

Entrant Information (if applicable)

Recent Stage Results

Permission

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

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.


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