Consett & District Motor Club
TRIALS ENTRY FORM
24th October 2021 Butsfield Quarry (Permit ACU61927)
11.00am Start - The supplementary Regulations and Entry payment details will be emailed to you direct from the club once your entry has been registered.
Name
*
First Name
Last Name
Email
example@example.com
ACU Licence Number
*
Address
Street Address
Street Address Line 2
City
County
Postal / Zip Code
Phone Number
*
Date of Birth (under 18s Only)
-
Month
-
Day
Year
Date
Signature of Parent or Guardian for under 18s only
Club
*
Machine entered
*
Capacity (CC)
Class
*
Please Select
EXPERT
INTER
NOVICE
YOUTH A
YOUTH B
YOUTH C
TWINSHOCK
PRE 65
Course
*
Please Select
EXPERT
GREEN
CLUBMAN
EASY
Riders Signature
*
Submit
Should be Empty: