Rallysport Ontario

2012 Rallysport Ontario ORRC COMPETITOR ENTRY Form

Please select the event you intend to enter:

January Jaunt (TAC) Jan 7 Rideau Winter Rally (MCO) Jan 21 Maple Leaf Winter Rally (MLRC) Feb 18
Spring Run Off (PMSC) Apr 28 Blossom Rally (KWRC) May 12 Discover Ontario Car Rally (TAC) Jun 16
No Winter Maintenance Rally (SPDA) Sept 29 Fall Night Rally (MCO) Nov 3
Presidents Prize Rally (PMSC) Nov 17 Northern Lights Rally (KWRC) Dec 1

Class:

Expert     Intermediate     Novice    

By checking this box, I agree to pay the organizing club for my entry, and to fill out all required paperwork and waivers at the event registration. I also acknowledge that this form is not necesarrily secure, and will only fill in information that I feel comfortable doing.

Driver:

Name/Nom:
Address/Adresse:
City/Ville:
Prov./State:
Code:
Phone/Tel:
Club:
email:
Driver's licence no.
No de permis de conduire:

Navigator:

Name/Nom:
Address/Adresse:
City/Ville:
Prov./State:
Code:
Phone/Tel:
Club:
Email:

Driver Emergency Contact:

Name/Nom:
Address/Adresse:
City/Ville:
Prov./State:
Code:
Phone/Tel:

Navigator Emergency Contact:

Name/Nom:
Address/Adresse:
City/Ville:
Prov./State:
Code:
Phone/Tel:

The vehicle is owned by:

Driver Navigator The following person:

Vehicle Owner:

Name/Nom:
Address/Adresse:
City/Ville:
Prov./State:
Code:
Phone/Tel:
Club:
Email:

Vehicle/Vehicules:

Year/Annee:
Make/Fabricant:
Model/Modele:
Colour/Couleur:
Licence plate no.
No d'immatriculation:
Prov/State:
Insurance Co./Cie d'assurance:
Policy No./No de police: