Wigan & District Motor Club

Entry Form

Event: Adgespeed Stages 2021, Three Sisters Race Circuit, Wigan on Sunday 10th October 2021

Entry Closing Date: Friday 08th October 2021

It is the responsibility of the entrant to complete all sections of this form. The Secretary of the Meeting has the right to refuse any incomplete or incorrect entry. Final Instructions, Entry list and results will only be published on the Motor Club web site:-

Driver

Basic Details

(Relevant clubs only please)
Yes
No

Contact, In case of emergency

Driver's Championships

The A.N.W.C.C. Stage Rally Championship 2021
The A.N.W.C.C. Ladies Rally Championship 2021
The A.N.W.C.C Allrounders Championship 2021
The SD34MSG Interclub League 2021 (Supported by Gazard Accounts)
The SD34MSG Stage Rally Championship 2021. (Supported by Gazard Accounts)
Heart Of England Stage Rally Championship 2021

Co-Driver

Basic Details

(Relevant clubs only please)
Yes
No

Contact, In case of emergency

Co-Driver's Championships

The A.N.W.C.C. Stage Rally Championship 2021
The A.N.W.C.C. Ladies Rally Championship 2021
The A.N.W.C.C Allrounders Championship 2021
The SD34MSG Interclub League 2021 (Supported by Gazard Accounts)
The SD34MSG Stage Rally Championship 2021. (Supported by Gazard Accounts)
Heart Of England Stage Rally Championship 2021

Vehicle Details

CC
Naturally Aspirated
Turbo
Supercharged
Rotary

Sponsor details (if applicable)


Recent Stage Results





Permission

BACS Transfer

BACS transfers can be made to: - Lloyds Bank. Sort Code:- 30 17 48 Account number:- 00145819

Account Name:- Wigan & District Motor Club (Rally Account).

Please use driver or co-driver's name as a reference.



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