Stage Masters Registration Form

Select Payment Option*

Online Payment
Cheque Payment

Cheque Payments

Download the Registration Form here

Please send completed form with full remittance to the Championship Secretary: Martin Leonard 2 Tai Canol, Llangorse, ,BRECON, Powys LD3 7UR

Driver

Name

First Last

Address

Street Address Address Line 2 City ZIP / Postal Code

Email

Mobile No.

Phone No.

HRCR No.

HRCR Expiry Date

Navigator

Name

First Last

Address

Street Address Address Line 2 City ZIP / Postal Code

Email

Mobile No.

Phone No.

HRCR No.

HRCR Expiry Date

Car Details

You will not be committed to only using this car on championship events

Make*

Reg No.*

Model*

Year*

Engine Capacity*

Class: Article 10*

Details of a relative or friend to be informed in the case of a serious accident

Driver

Name

Address

Phone No.

Relationship

Navigator

Name

Address

Phone No.

Relationship

Consent of Parent / Guardian (if under 18)

Driver

Name

Address

Phone No.

Relationship

Navigator

Name

Address

Phone No.

Relationship

Declaration

Download the Championship Regulations here

Declaration*

I have read and understand the regulations for this challenge and agree to be bound by them.

Data Protection

I Agree

DATA PROTECTION ACT/ GENERAL DATA PROTECTION REGULATION: The information declared above will be held on computer for membership administration and HRCR event or championship / series purposes only; including emailing you about Club events and Club newsletter. Please tick to confirm you are happy for us to use your personal data in this manner

Fees

Price*

Driver - £20.00
Navigator - £20.00
Crew Registration, driver and navigator - £40.00

Fee Enclosed

£ 0.00

Fee Enclosed

£ 0.00

Fee Enclosed

£ 0.00

Credit Card

Card Details

Cardholder Name