A.N.E.C.C.C Autocross Championship

2012

Competitors Registration Form

NAME………………………………………………………………………………….

ADDRESS……………………………………………………………………………..................

………………………………………………………………….………………………

……………………………………POST CODE……………………………………..

TELEPHONE (H) ……………………………. (M)…………………………………

E- MAIL……………………………………………………………………………….

MSA REGISTERED CLUB…………………………………………………………..

CAR MAKE……………………..MODEL…………….CAPACITY……………….

CLASS………………… CLASS REGISTRATION No……………………………

(Preferred numbers are given on first come first served basis unless previous year class winner)

I hereby agree to be bound by the regulations of the A.N.E.C.C.C. Autocross Championship regulations for 2012

Signed……………………………………………………..

Please forward to the Championship Co-ordinator when complete along with the required registration fee. £45.00

Please do not send cash,

Cheques to be made payable to A.N.E.C.C.C. Autocross Championship

Send to

Mr Maurice Mabon

70,Chapel Lands

Alnwick

Northumberland

NE66 1ER