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***** ________________________ RACE - ENTRY FORM ***** RACE NUMBER __________

FULL NAME _________________________________________________ AGE ____________

ADDRESS ____________________________________________________________________

_____________________________________________________________________________

PHONE NUMBER_________________________________ VEHICLE REG __________________

CLUB _______________________________________________________________________

CATEGORY (tick as appropriate)

Male_____ Junior_____ Intermediate _____ V40_____ V45_____ V50_____ V60_____ V70_____

Female ____ Junior _____ Intermediate _____ LV40_____ LV45_____ LV50 _____ LV60_____

I understand that this race is held in accordance with the rules and safety requirements of the FRA. I am aware of the organiser’s information and stipulations and I accept that any injury occurring to me during the course of the race is in no way the responsibility of the race organiser.

SIGNED____________________________________________________________________

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