Hillclimb and Sprint Association Hillclimb and Sprint Association


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ONLINE HSA CHAMPIONSHIP REGISTRATION 2013

Title:
First Name:
Surname:
Email address:
Postal Address:
 Line 1
Line 2 (optional)
Town/City
County (optional)
Postcode:
Date of Birth: (dd/mm/yyyy)
Do you hold a valid road traffic licence?:
Competition licence no:     Grade:
Contact numbers. Please enter at least one of the following:
Home Phone:
Mobile Phone:
Work Phone:
Car details:
Make:
Year:
Type:
Capacity:
Engine: Turbocharged   Supercharged   Rotary   Diesel  
Class:
HSA membership no:   (if known)
If you are under 18 please enter guarantor (parent/guardian) details below:
Name:
Address:
Relationship:
I hereby request that I be listed as a competitor in the SBD HSA Speed Championship for 2013. I have applied for the appropriate type and grade of competition licence and I am a member of the HSA. I undertake to abide by the regulations governing the championship and the rules of the Motor Sports Association.
  Please tick the box to confirm.