EmailMe Form - Weald 12 car Entry Form (Blackpalfrey)

Event *

10th December 2021 - Entry Fee £15

Driver *

First Last

Driver's Address and Postcode *

Driver's Email *

Confirm

Drivers Phone *

Driver's Licence No. *

Driver's Club

Navigator *

First Last

Navigator's Address and Postcode *

Navigator's Email *

Confirm

Navigator's Phone

Navigators Licence No. *

Navigator's Club

Class *

Expert

Semi-Expert

Novice

Beginner

Please see Regs for Class Details

Car Make / Model *

Car Year of Registration *

Registration Number *

Will be using JELF Insurance *

Yes

No

If using own insurance please provide insurers name

Insurance Policy No.

Name of Person to be contacted in the event of an Accident *

First Last

Address and Postcode of person to be contacted in the event of an accident *

Phone number of person to be contacted in the event of an accident *

Entry Fee Payment Method *

On-line Bank Transfer (preferred, details will follow)

Cheque in the post (address will follow)

Pay on the day

Note: If you choose to pay on the day your entry will remain as provisional and you may find yourselves on the reserves list if the event is oversubscribed.