Name *

First

Last

Registration *

• Standard Registration €40.00
• Junior €25.00
• J1000 €15.00

Competitor Type *

• Driver
• Navigator

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

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Information

Email *

Mobile Number *

Competition Licence Number *

Licence Grade *

Issuing Association *

• Motorsport Ireland
• MSA
• Other

Car Registration

Car Make & Model *

Car Registration Number *

Engine Cubic Capacity *

Valves Per Cylinder *

• Two vales per cylinder
• More than two valves per cylinder

Turbo *

• Yes
• No

2 Wheel Drive OR 4 Wheel Drive *

• 2 Wheel Drive
• 4 Wheel Drive

Grp N *

• No
• Yes

Grp R *

• Yes
• No

Group Entered (see article 4) *

• Group J1000 - 15,00 €
• Group 1 - Juniors - 25,00 €
• Group 2 - 40,00 €
• Group 3 - 40,00 €
• Group 4 - 40,00 €
• Group 5 - 40,00 €
• Group 6 - 40,00 €
• Group 7 - 40,00 €

Choose your Nominated Event for Double Points 2023 (see article 7) *

• Round 1: Moonraker Forestry - 15th April
• Round 2: Tipperary Forestry - 14th May
• Round 3: Wexford Rally Sprint - 11th June
• Round 4: Carlow RallySprint - 25th June
• Round 5: Ravens Rock Rally - 02nd July
• Round 6: Carrick On Suir Rally Sprint - 27th August
• Round 7: Wexford Volkswagen Stages Rally - 09th September
• Round 8: Wexford Volkswagen Stages Rally - 10th September
• Round 9: Carrick on Suir - Willie Loughman Forestry Rally - 08th October

Club Member *Choose your club by clicking hereWexford Motor ClubCarrick on Suir Motor ClubCarlow Car ClubTipperary LC & MCMunster Car ClubOther

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