MCAC Competitors Claim Form

In conjunction with Anglia Motorsport Club Middlesex County Automobile Club and Harrow Car Club are pleased to be organising this AutoSolo, Autotest & PCA in 2022.

Please ensure you fill in the entry form correctly. To ensure you are considered for a place on the accepted list you should pay the entry fee as soon as you can.
Name of Person Competing *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Email *
example@example.com
Club *
MSUK RS Licence NUmber *
I hold a full RTA licence *

Yes No
Age of Driver *

Over 18 Over 13 and under 18
Car Details
Make & Model *
Capacity *
Reg Number *
Forced Induction *

Yes No
Diesel *

Yes No
Car to be shared with (if applicable)
Event Entering *
How are you getting your car to the venue? *

Driving it Trailering it
Airfield Security
Are you coming on your own *

Yes No
If 'No' Please add details of other people
Details in case of emergency
Name *

First Name Last Name
Phone number *
Data Protection

By pressing enter below you agree to your information being held securely by MCAC under the conditions here
Payment
Please Choose payment method before proceeding
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PayPal - Debden AutoSOLO, AutoTest & PCA 2022 £ 40.00
Only select this if you wish to pay by PayPal otherwise continue to submit entry and pay via Bank Transfer separately.

Total £ 0.00
Bank Transfer - Debden AutoSOLO, AutoTest & PCA

Please use the Bank details below to transfer the entry fee as soon as possible

Middlesex County Automobile Club Ltd

NatWest,

Ruislip branch

Sort Code 60-18-05

Account number 70671745
Indemnity

I declare that I have been given the opportunity to read the General Regulations of the Motor Sports Association and the Supplementary Regulations for this event and agree to be bound by them. I declare that I am physically and mentally fit to take part in the event and I am competent to do so. I acknowledge that I understand the nature and type of competition and the potential risk inherent with Motor sport and agree to accept that risk.

I confirm that I have read the latest version of the event regulations on the website or e-mail

I understand the Covid19 elements and will abide by the requirements.

By submitting this form you agree to the above Indemnity
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Car Details

Airfield Security

Details in case of emergency

Payment