REGISTRATION

Shannonville Stages & Sprint

* Indicates a required field

Event Selection

Registering for which Event(s)? *
OPRC RallyRally Sprint

Driver Information

Driver Name (First and Last) *

Driver class*
NoviceExpert
Phone Number *

Address *

City *

Province *

Postal Code *

Email *

Rally Club Affiliation

Competition Licence no *

CARS-NatRegARANASAFIARallysprint

Emergency Contact Information

Contact Name *

Relationship *

Contact Phone *

Co-Driver Information

Co-Driver Name (First and Last) *

Phone Number *

Address *

City *

Province *

Postal Code *

Email *

Rally Club Affiliation

Competition Licence no *

CARS-NatRegARANASAFIARallysprint

Emergency Contact Information

Contact Name *

Relationship *

Contact Phone *

Vehicle Class *
Prod - 2WDOpen - 2WDProd - 4WDOpen -4WDRally Sprint 2WDRally Sprint 4WD
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 & co-driver and indicate the names of the other drivers EACH time.

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

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]