REGISTRATION

* Indicates a required field
Supplementary Regulations *

I have read the supplementary regulations:
YesNo

Rain Date

If the event is rained out, will you attend the rain date on August 17th? *
YesNo

Driver Information

Driver Name (First and Last) *

Phone Number *

Address *

City *

Province *

Postal Code *

Email *

Rally Club Affiliation

Emergency Contact Information

Contact Name *

Relationship *

Contact Phone *

List your Ontario Rally X Championship ORXC Car number

Number*

Vehicle Information

Vehicle Class *
Class 1 - 2WDClass 2 - NA AWD no Side by SidesClass 3 - Turbo AWD and Side by SidesClass 4 - Exhibition Only. Any driver with CARS or ARA seed of 1 2 or 3

Vehicle Year (YYYY) *

Vehicle Make *

Vehicle Model *

Vehicle Colour *

Shared Vehicle? *

YesNo

For all shared vehicles, please fill out a registration form for EACH driver and indicate the names of the other drivers EACH time. Ex. Three people ( Maximum allowed) sharing one car will have 3 registration forms filled out. This helps load the automatic entry list correctly and accurately for all driver entrants. Thanks!

Shared Drivers (please list names of all other drivers sharing this vehicle)

Service Person (please list names of all Service People spouses friends )

Payment Methods

PMSC is not set up to receive credit card or PayPal payments. Payment options are therefore as follows:

1) Pay by Cheque - Please make cheques payable to Peterborough Motor Sports Club and mail your cheque to the following address:
c/o Pete Gulliver
1026 Communication Road
Selwyn ON  K9J 6X2

2) Pay by Interac email money transfer - Please send money transfers to rallyx@pmsc.on.ca

How are you planning to pay? *

ChequeInterac E-Transfer

[By Supplying your Name and E-Mail you accept conditions of Event Registration]