Actc Entry Form

ACTC ENTRY FORM

/ 2016 /

Date

Entrant’s Details

First Name / Last Name
Address
Post Code
Phone Number / E-mail Address

I am subscribing to RESTART magazine ONLY

/ YES / NO
I am entering the Drivers’/Riders’ championships (includes Restart magazine) / YES / NO
I am entering my Navigator for the Navigators Championship without Restart OR / YES / NO
I am entering my Navigator for the Navigators Championship with Restart / YES / NO
Entrant: I would like to receive my copies of Restart by e-mail to the above e-mail address / YES / NO

......

DRIVERS/RIDERS ENTERING THE CHAMPIONSHIPS MUST FILL IN THE FOLLOWING:

I wish to enter the / Car Drivers’ Championships / Pouncey League / Red Rose Bowl

(please delete as appropriate)

Applicants must be a member of an ACTC affiliated club (Car Drivers) or an ACU or ACMA affiliated club, depending on the event, for Motorcycle Riders

Please read and then sign the following declaration

I do not hold a competition licence from any club other than the Motorsports Association (MSA) or the ACU or AMCA (as appropriate). I have a current UK driving licence and I agree to keep to the general competition rules of the MSA or the ACU and AMCA and to the rules of the ACTC. If entering the Motorcycle Championships I confirm that I (and my passenger in the case of the Red Rose Bowl) are registered with the ACU or AMCA as Trials Riders.

Signature / Current ACTC Competitor Number

All Car and Motorcycle Entrants will be sent SRs and Entry Forms for Championship Events (except Motorcycle only events and MCC events) and certain other qualifying events. The preferred method of delivery is E-mail

Entrant: I would like to receive my SRs and Entry Forms by e-mail to the above e-mail address / YES / NO

......

NAVIGATOR’S CHAMPIONSHIP (Cars Only)

If you want your navigator to compete for championship points and/or receive the Restart magazine, please add their details below:

First Name / Last Name
Address
Post Code
Phone Number / E-mail Address
I would like to receive my copies of Restart by e-mail to the above e-mail address, if applicable. / YES / NO

......

FEES ENCLOSED

RESTART Magazine only / £11.00 / All Cheques to be made payable to ACTC
Driver’s/Riders’ Entry Fee (includes RESTART) / £17.00 / and sent with this for to:
Navigators’ Entry Fee (NO RESTART) / £6.00 / Giles Greenslade
Navigators’ Entry Fee (with RESTART) / £11.00 / 11 Haygrove Close, Warminster
TOTAL / Wilts, BA12 8SL

Please note that the details you give on this form will be kept in computer files, unless you tell us otherwise.

ACTC Entry Form 2016-1