International Car Rally Entry Form
(May 10th – 13th May 2019)
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@gmail.com
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.
