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

2010

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 2010

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 Tom Fawcett

Dewley Croft

Throckley

Newcastle upon Tyne

NE15 9RE Tel. No. 01661 825104