2019 May rally entry form

International Car Rally Entry Form

(May 10th – 13th May 2018)

Kinsale Vintage & Classic Motor Club

Hon. Secretary: Ann O’Regan, Tuosist House, Knockleigh, Belgooly, Co. Cork. P17 CR98

TEL. 00 353 (0)87 6822853 e-mail annsl350@eircom.net

www.kinsalevintageclub.com

 

Entry Fee per vehicle – €25 for weekend

 

 

Entrant                     _________________________________________________

 

Address                     _________________________________________________

 

Telephone No:           Home __________________Work/Mob_________________

 

E-mail address           _______________________

 

I wish to enter the above event using the vehicle described below

 

Make             _______________________Vehicle____________________

 

H.P. or C.C    ________________ Reg. No. __________ Year ___________

 

Name of FIVA Affiliated club of which you are a member _________________

 

 

Declaration of insurance

 

 

I declare that during the whole period of the event my car and any Driver thereof will be covered by valid and subsisting insurance as Required by the Road Traffic act 1961 and that such insurance shall Include Rally cover and I undertake to produce to the Clerk of the Course, Scrutineer or other duly authorised official of the Certificate of Insurance On demand.

 

Insurance Co.            _________________ Policy No ______________________

 

Expiry Date   _________________

 

Signature of Driver _______________________________________________

 

Insurance Disc must be displayed.    No disc – No Start.

 

N.B.   

  Social Evenings: Trident Hotel  Saturday 11th €25.00 per head. Hamlets Sunday evening €15 per head. To be paid with rally entry.

           

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