Historic Rally Association, Inc
Entry Form - Rally/Road
OFFICE USE ONLY
CLASS
CAR NUMBER
DATE ENTRY RECEIVED
/
Day
/
Month
Year
Date
ENTRY APPROVED
DATE
/
Day
/
Month
Year
Date
TIME
Hour Minutes
Held under the ISC of the FIA and the National Competition Rules of Motorsport Australia
41st Anniversary George Woods Rally 20/02/2021
Competitor to complete rest of form
Driver
DRIVER'S SURNAME
*
DRIVER'S GIVEN NAME
*
DRIVER'S MOTORSPORT AUSTRALIA GRADE
*
Please Select
F
E
D
C
B
DRIVER'S HRA GRADE
*
Please Select
C
B
A
N/A
DRIVER'S MOTORSPORT AUSTRALIA LICENCE NO.
*
DRIVER'S MOTORSPORT AUSTRALIA LICENCE EXPIRY
*
/
Day
/
Month
Year
Date
DRIVER'S MOTORSPORT AUSTRALIA AFFILIATED CLUB
*
DRIVER'S CLUB MEMBERSHIP NO.
*
DRIVER'S CLUB MEMBERSHIP EXPIRY
*
/
Day
/
Month
Year
Date
DRIVER'S STREET ADDRESS
*
SUBURB
*
STATE
*
POSTCODE
*
DRIVER'S EMAIL
*
example@example.com
DRIVER'S MOBILE/PHONE
*
DRIVER'S EMERGENCY CONTACT NAME
*
DRIVER'S EMERGENCY CONTACT NUMBER
*
Please enter a valid phone number.
DOES DRIVER HAVE AMBULANCE COVER?
*
YES
NO
DOES DRIVER HOLD A CURRENT CIVIL LICENCE? If YES, Driver's civil drivers licence must be presented at documentation. If NO, Driver MAY NOT drive in the event
*
YES
NO
DOES DRIVER NEED AN OBSERVED LICENCE TEST?
*
YES
NO
Co-Driver/Navigator
NAVIGATOR'S SURNAME
*
NAVIGATOR'S GIVEN NAME
*
NAVIGATOR'S MOTORSPORT AUSTRALIA GRADE
*
Please Select
F
E
D
C
B
A
NAVIGATOR'S HRA GRADE?
*
Please Select
C
B
A
N/A
NAVIGATOR'S MOTORSPORT AUSTRALIA LICENCE NO.
*
NAVIGATOR'S MOTORSPORT AUSTRALIA LICENCE EXPIRY
*
/
Day
/
Month
Year
Date
NAVIGATOR'S MOTORSPORT AUSTRALIA AFFILIATED CLUB
*
NAVIGATOR'S CLUB MEMBERSHIP NO.
*
NAVIGATOR'S CLUB MEMBERSHIP EXPIRY
*
/
Day
/
Month
Year
Date
NAVIGATOR'S STREET ADDRESS
*
SUBURB
*
STATE
*
POSTCODE
*
NAVIGATOR'S EMAIL
*
example@example.com
NAVIGATOR'S MOBILE/PHONE
*
-
Area Code
Phone Number
NAVIGATOR'S EMERGENCY CONTACT NAME
*
NAVIGATOR'S EMERGENCY CONTACT NUMBER
*
DOES NAVIGATOR HAVEAMBULANCE COVER?
*
YES
NO
DOES NAVIGATOR HOLD A CURRENT CIVIL DRIVER'S LICENCE? If YES, Navigator's civil drivers licence must be presented at documentation If NO, Motorsport Australia Declaration of Co-Driver Without Civil Licence form must be completed and sent with entry
*
YES
NO
DOES NAVIGATOR NEED AN OBSERVED LICENCE TEST?
*
YES
NO
Competitor
Vehicle Owner or person with written permission of owner to enter it in the event. Such permission must be presented at documentation.
COMPETITOR'S SURNAME
*
COMPETITOR'S GIVEN NAME
*
COMPETITOR'S MOTORSPORT AUSTRALIA LICENCE NO.
*
COMPETITOR'S LICENCE EXPIRY
*
/
Day
/
Month
Year
Date
COMPETITOR'S EMAIL
*
example@example.com
COMPETITOR'S MOBILE/PHONE
*
Description of Car
VEHICLE MAKE
*
MODEL
*
BODY TYPE
*
COLOUR
*
YEAR
*
CAPACITY
*
DRIVE?
2WD
4WD
FORCED INDUCTION? Turbo-or Super-charged?
YES
NO
CLASS FOR THIS EVENT
Please Select
R1 - Rally Car up to 2000cc
R2 - Rally Car over 2000cc
O1 - other car up to 1600cc
O2 - other car over 1600cc
A - SCC 1974 and earlier
B - SCC 1975 to 1987
C - SCC 1988 or later
PERMIT OR REGISTRATION NUMBER
*
PERMIT OR REGISTRATION EXPIRY (if applicable)
*
/
Day
/
Month
Year
Date
UNREGISTERED VEHICLE PERMIT?
YES
NO
N/A
MOTORSPORT AUSTRALIA LOGBOOK NUMBER
SCC LOG CARD NUMBER
Service Crew Details
COMPETITOR NAME
SERVICE CREW MEMBER 1 -NAME
SERVICE CREW MEMBER 1 - MOBILE PHONE NUMBER
SERVICE CREW MEMBER 2 -NAME
SERVICE CREW MEMBER 2 - MOBILE PHONE NUMBER
SERVICE CREW MEMBER 3 -NAME
SERVICE CREW MEMBER 3 - MOBILE PHONE NUMBER
SERVICE CREW MEMBER 4 -NAME
SERVICE CREW MEMBER 4 - MOBILE PHONE NUMBER
SERVICE CREW MEMBER 5 -NAME
SERVICE CREW MEMBER 5 - MOBILE PHONE NUMBER
Service Vehicle 1
SERVICE VEHICLE 1 - MAKE
SERVICE VEHICLE 1 - MODEL
SERVICE VEHICLE 1 - YEAR
SERVICE VEHICLE 1 - REGISTRATION NO.
SERVICE VEHICLE 1 - STATE OF REGISTRATION
SERVICE VEHICLE 1 - COLOUR
Service Vehicle 2
SERVICE VEHICLE 2 - MAKE
SERVICE VEHICLE 2 - MODEL
SERVICE VEHICLE 2 - YEAR
SERVICE VEHICLE 2 - REGISTRATION NO.
SERVICE VEHICLE 2 - STATE OF REGISTRATION
SERVICE VEHICLE 2 - COLOUR
The Motorsport Australia Risk Warning, Disclaimer and Indemnity must be completed by the Competitor, Driver and Navigator.
These can be downloaded by clicking this link: motorsport-australia_disclaimer.pdf
Submit
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