Malcolm Wilson Rally - 3rd March 2012

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Standard Entry Fee (£420) + 3.5%

Rally First Entry Fee (£370) + 3.5%

Insurance (£25) + 3.5%

Management Pack (£25) + 3.5%

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All Prices Include a 3.5% Administration Fee.

2012 Malcolm Wilson Rally - Entry Form (Return by post) or Enter Online
Please download and complete the PDF file(s) listed below.

Enter Online - Complete Details Below (All Sections Must Be Completed).

Main Driver Name:	Co Driver Name:
Main Driver Address (Inc Postode):	Co Driver Address (Inc Postcode):
Main Driver Telephone:	Co Driver Telephone:
Main Driver Mobile:	Co Driver Mobile:
Main Driver E-mail Address:	Co Driver E-mail Address:
Main Driver License Number :	Co Driver License Number :
Main Driver BTRDA:	Co Driver BTRDA:
Main Driver Club:	Co Driver Club:
Final instructions, including Road Books, will be sent out by Courier in the week prior to the event and will need a signature to be delivered. Please make sure there is someone at this address to receive them. Final Instructions and Road Book will be delivered to the main drivers address unless you specify a different delivery address below.
Only Complete If You Require Final Instructions and Road Book To Be Delivered To An Address Other Than The Main Drivers Address.

Previous Finishes (Last 6 Events) This Information Will Be Checked
Year:	Event:	Status:	Class:	Overall:

Insurance Details
Insurance Company Name:	Insurance Company Address:

	Tick This Box If You Comply With REIS requirements.
	If Not, Tick This Box If You Require A Proposal Form.

Championships
	Driver:	Co Driver:
Swisher MSA English Rally
REIS - Get Connected BTRDA Gold Star
REIS - Get Connected BTRDA Silver Star
Millers Oils BTRDA 1400
Rallyschool.co.uk BTRDA Rally First
DMACK Tyres BTRDA Historic Cup
MG ZR Rally Challenge
Fiesta Sport Trophy & Fiesta Sport Challenge
Motorscope Northern Historic Rally
S G Petch ANECCC Stage
ANWCC Forest & Historic Stage

Press Information
In order to assist our Media Team and of course, to promote your sponsors, it would be helpful if you could enter the names of your sponsors below. Please add any local radio stations and / or any other information in this space.
Please Complete.

Payment Information

	Please Tick This Box If You Are Paying For Your Entry Online Through Paypal.
	Please Tick This Box If You Are Paying By Cheque.

All Cheques should be posted to: Ian Wright, 14 Monkswell Drive, Bolton-le-Sands, Carnforth, Lancashire. LA5 8JZ