2005 Le Jog Trial Entry Form

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2005 Le Jog Trial Entry Form














HERO Lands End to John oGroats Reliability Trial 2008
Supported by Mann-Filters

ENTRY APPLICATION FORM

(
PLEASE COMPLETE
BOTH
SIDES
)



First Driver


Second Driver

Surname

(Mr/Mrs/Miss/Ms/Dr - delete as applicable)

(Mr/Mrs/Miss/Ms/Dr - delete as applicable)
Usual first name


Age (if under 18)



Declared Nationality
(UK specify ENG.WAL, SCO, NI, CI))


Postal address


Telephone : work/mobile : home : Fax : E-mail



E.mail is our preferred method of communication please print clearly


*HERO member? If yes, give number


Motorsport/driving experience



Next of kin: name
Address/tel/fax




OTHER CREW MEMBERS:
*NB all crewmembers must be HERO members membership is included in your entry fee.
No 3: Name ______________________ Nat.______ Age (if 17 or under) ______ *HERO member? Yes No ________Number
No 4: Name ______________________ Nat.______ Age (if 17 or under) ______ *HERO member? Yes No ________Number

INSURANCE: (Tick whichever box applies)
We comply with, and will sign, the competition car insurance declaration: 1
st
Drivers initials ______ 2
nd
Drivers initials _____
We will be covered by our own insurance policy valid for the event, as follows: Name of company _________________________________________________________ policy no _______________________

VEHICLE:

Make _______________________________________ Model and variant ___________________________________
Body type: saloon drophead/tourer open sports GT/closed coupe No of seats __________________ Year of manufacture _______________ Date of first registration _______________ Engine size ______________ cc Registration no: ____________________ Country letter(s) (eg GB, NL) _____________
Supplementary odometer: make & model ___________________ electronic
mechanical No of distance displays _____
HERO Declaration of Vehicle Eligibility:
photocopy attached** send Guidelines and Declaration Form


Historic/rarity interest:
** DONT send the original please keep on file for future events
Continued overleaf
(pnLJtrial08)








L
E
J
OG
2008 Reliability Trial entry form contd Name: _____________________________________________

NOVICE ELIGIBILITY - Please refer to supplementary regulations & tick one of the following boxes as applicable:

Beginners wishing to compete for main medals Beginners wishing to compete in Category N

TEAM ENTRY (other than Golden Oldie you may be in just one Team of each type - see HSRs Article 6.5):


Name of team
Other team members (teams of three or four; Golden Oldie - two only)
Marque
2
3
4

_