Maurice Crabb Trial, Uploders, 12th Jan 2025

Driver Details

Name*

First Last

Address*

Address Line 1 Address Line 2 City County Post code Country

Phone*

Mobile

Email*

RTA Driving Licence*

Do you hold a valid Road Traffic Act driving licence?

Status*

Club*

I am a fully paid up member of:

Competition Licence Type & Number*

Minimum Clubman RS

Driver Emergency Contact

Relative or friend to be contacted in the event of a serious accident.

Full Name*

Address*

Phone*

Mobile

Would you like to enter Passengers Details?*

Passenger Details

Passenger: Name*

First Last

Passenger: Address*

Address Line 1 Address Line 2 City County Post code Country

Passenger: Phone*

Passenger: Mobile

Passenger: Email*

Passenger: State your age if you are under 18

Enter a whole number i.e. 16

Parent Guardian

Any indemnity and / or declaration as prescribed above which is signed by a person who has not reached his or her eighteenth birthday shall be countersigned below by that person’s parent or guardian, whose full name and address shall be given.

Signed - parent / guardian - Passenger

Parent / Guardian Address

Address of parent / guardian of Passenger

Passenger: Club*

I am a fully paid up member of:

Passenger: Competition Licence Type & Number*

Minimum Clubman RS

Passenger Emergency Contact

Relative or friend to be contacted in the event of a serious accident.

Full Name*

Address*

Phone*

Mobile

Vehicle Details

Make of Vehicle*

Model*

Engine Capacity*

Registration No.*

Tyre Make/Size*

Class*

See SR's for full details

Entry Fee

Is the car double driven?*

Name of other driver*

Are both drivers adults?*

Are both drivers paying individually?*

Who is paying?*

Membership Fee

Many renewals are due around this time of year - check the expiry date on your membership card & renew here if necessary.

Would you like to renew your Woolbridge MC Membership*

Competing Family Membership

(add on to full membership, £2.50 each)

Entry Fee Total

Declaration

Declaration*

I declare that I have been given the opportunity to read the National Competition 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 the competition and the potential risk inherent with motor sport and agree to accept that risk. Further, I understand that all persons having any connection with the promotion and/or the organisation and/or conduct of the event are insured against loss or injury caused through their negligence.

I agree to be bound to the above declaration

State your age if you are under 18

Enter a whole number i.e. 16

Parent Guardian

Any indemnity and / or declaration as prescribed above which is signed by a person who has not reached his or her eighteenth birthday shall be countersigned below by that person’s parent or guardian, whose full name and address shall be given.

Signed - parent / guardian - Driver

Parent / Guardian Address

Address of parent / guardian of Driver

Payment

Please note:

The fee can be paid by Credit Card, Debit Card or PayPal by completing this online form and clicking on the PayPal button below.

You will then be given the option to either pay using your PayPal account, or if you don’t have a PayPal account, or don’t wish to use it, click on the ‘Pay by Debit or Credit Card’ option to use your own debit or credit card.

Total

Maurice Crabb Trial, Uploders, 12th Jan 2025

Driver Details

Driver Emergency Contact

Passenger Details

Parent Guardian

Passenger Emergency Contact

Vehicle Details

Entry Fee

Membership Fee

Declaration

Parent Guardian

Payment

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