GBMC RS Clubmans Autocross Entry

GBMC - RS Clubmans Autocross Entry Form

14th August 2022 - Old Park Farm, Perry Green
Name: *
Address Line 1: *
Address Line 2:
City: *
Postal Code: *
E-Mail Address *
Phone Number *
Club *
MSUK RS Licence Number *
I Hold a Full RTA Licence *

Yes No
Age of the driver named above

Over 18 14-17
If entrant is under 18 please complete the declaration below

I am the Parent / Guardian of the entrant ‘I understand that I shall have the right to be present during any procedure being carried out under the Supplementary Regulations issued for this event and the General Regulations of the MSUK’.

As the Parent / Guardian ‘I confirm that I have acquainted myself with the MSUK General Regulations, agree to pay any appropriate charges and fees pursuant to those regulations (to include any appendices thereto) and herby agree to be bound by those Regulations and submit myself without reserve to the consequences resulting from those Regulations (and any subsequent alteration thereof). Further, I agree to pay as liquidated damages any fines imposed upon me up to the maxima set out in Part 3 Appendix 1.’
Age of entrant
PG Name:
PG Address Line 1:
PG Address Line 2:
PG City:
Postal Code:
PG Phone Number
I agree to the declaration

Yes No
Car Details
Make and Model *
Capacity *
Reg Number
Preferred Comp Number
Forced induction *

Yes No
Diesel *

Yes No
Car to be shared with (if applicable)
Classes

A1 Standard Production up to 1600 cc A2 Standard Production over 1600 cc B Modified Production based cars up to 1400 cc C Modified Production based cars 1401 to 1650 cc D Modified Production cased cars over 1650cc E1 Specials E2 All Four Drive Vehicles F Junior Autocross G1 Stage Rally Cars 2WD up to 1600cc G2 Stage Rally Cars 2WD over 1600cc
Please note that we can only accept payment by bank transfer for this event.
Transfer details will be sent when you submit this entry form.
Juniors Payment *

By Bank Transfer £40.00
AMSC Payment *

By Bank Transfer £60.00 Non AMSC £65.00
Payment due
Details in case of emergency
Name: *
Phone Number: *
Address Line 1:
Address Line 2:
City:
Postal Code:
Data Protection

GBMC is asking for all the above information because we need it to run the event properly. For full details please go to This page on our website.
Indemnity

I declare that I have been given the opportunity to read the General Regulations of the Motorsport UK and, if any, 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 the 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.

I understand the Covid19 (if needed) elements and will abide by the requirements.

By submitting this form you agree to the above Indemnity
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GBMC - RS Clubmans Autocross Entry Form

Car Details

Details in case of emergency