Mon 25th AM PM

Your Details

* First name:

Gender:

* Address:

Area:

* Town/City:

County:

* Postcode:

Country:

Your Club

Phone number:

Alternative:

*E-mail: Address

* Select Your Club: * Membership Number:

Emergency Contact

Please supply the name and phone number who  we can contact in the event of a medical  emergency. Name:

Phone number:

Alternative:   number

* Required entries

* Surname:

Under 18 Entrants

If under 18 at the time of the competition please tick the box below and then enter the subsequent name and contact number of Parent/Guardian.


*Parent/Guardian Name:



*Parent/Guardian Contact Phone*:



RTVyesno() CCVTyesno() Mobile number Tyro  RTV  CCVT Comp Team Timed

Pitch Requirements: One caravan or main tent plus children’s tent is considered as one standard pitch.
Pitch size 11M(W) X 9M(D) useable space 8M X 9M.

If you need additional space then please book an additional pitch.

Double Driver name (if applicable) with: Log book or Red Tag number of trialer: *Select CCVT Class: Enter your MSA competition Licence number:

Camping - Thur 25th May - Tue 31st May - £50.00 per pitch

Vehicle passes - £5.00 each

Tyro Trial - Sat 27th May - £20.00

*Select Tyro Class: Please fill out a separate form for the Double/Triple drivers Tyro Entry Fee £

Road Taxed Vehicle Trial - Sun 28th May - £35.00

Registration Number of vehicle: *Select RTV Class: Double Driver name (if applicable) with: RTV Standard Diesel trophy: Please fill out a separate form for the Double/Triple drivers RTV Fee £

Cross Country Vehicle Trial - Sat 27th May - £35.00

Double Driver name (if applicable) with: Please fill out a separate form for the Double/Triple drivers CCVT Fee £

Competitive Safari - Mon 29th May - £50.00

Log book or Red Tag number of Comp motor: *Select COMP Safari Class: Double Driver name (if applicable) with: Please fill out a separate form for the Double driver Comp Fee £

Team Recovery - Sun 28th May - £35.00 per team

Log book or Tag number of your motor: Team Recovery other driver’s name: Your Team’s name: Team Recovery Fee £

Concours D' Elegance - Sat 27th May - FREE

Vehicle model: Year: Registration Number: Concours D' Elegance Fee £

Children’s Bike Trial - Sun 28th May - FREE

Age of child
Child’s name and surname 1: 2: 3: 4:

Please enter the responsible Parent/Guardian’s name at the top of this form with their Club and contact details.

Children must be under 16, wear a helmet and supervised by an adult.

Further entries can be made by submitting more booking applications.

Entries will be accepted on the day.

Only one entry fee is payable: Each Team member must complete their own separate form if not all ready booked for camping or competition event.

Who is paying for  the Team entry? Additional pass(es) Fee £
Additional pass(es) : Camping Fee £

Which Club do you wish to camp with?
Note: this will update if you change your membership club.

Triple Driver name (if applicable) with: Triple Driver name (if applicable) with: Triple Driver name (if applicable) with: Any subsequent submitted form will be treated as an ADDITION to the original booking.    If you wish to cancel or delete all or part of a  booking then you must contact the Bookings Officer directly.  Cancellation terms and conditions apply Amendments to a previous submitted booking ALRC Levy £ Total for entries £ Select your preferred payment method *

Payment

* Required entries

Please quote your booking reference number on all correspondence.

A booking reference number is allocated when you press the submit button. This reference number will appear on the top of the next summary screen. We will also send you an automatic email with all the details you have supplied on this form.


If you have any issues or feedback on this booking process then please contact the Entries Secretary.
 
alrcbookings2017@btinternet.com

TOTAL payment due £

Payment method surcharge £

There will be an additional PayPal charge to use PayPal or credit/debit card as a payment method of 3.6% +20p per transaction.

If you wish to pay by Online Banking then we will include our account number details in your acknowledgement email.

If you are sending through an amendment which is valued £0, please select “other” as the preferred payment method  and put a note in the comments above.

Entrant

Marshalling

1 2

Comments

Please tell us anything else or any special requests:- Tyro  RTV  CCVT Comp Team Timed Additional Named

Please indicate which event you are willing to marshal in:-

First Aider? First Aider?

Please supply the names of people who are willing to help with Marshalling an event.

Please Answer/Do The Security Questions




*Select Vehicle Type: *Select Vehicle Type: *Select Vehicle Type:

If the Entrant is Under 18, please specify in the Under 18 section above above

Please tell us if you are bringing a lorry or motorhome?


Are provided one per competition entry
and one per camping entry.

Entering?

Entering?

Entering?

Entering?

Entering?

Entering?

Entering?

Your age as of 29th May17

Age based trophies

CCVT driver 55 to 64 trophy: CCVT driver 65  and over trophy:

Your Booking reference number will be displayed on the next booking summary screen.

If you are making an amendment to a previous booking please make a statement in the comments section at the bottom of this form. Please include your previous booking number if you know it.

©Dave Barrell-WWLRC with help from Andrew Neaves, Murray Wiltshire & Archey Barrell