SATURDAY OCT 8TH & SUNDAY OCT 9TH 2022

 

Please select which Event(s) you wish to enter

 

HSA members may deduct £5 for each day's entry (i.e. may deduct £10 if entering both days)

 

Driver details

First name*:

Last name*:

Address line 1*:

Address line 2:

Address line 3:

Address line 4:

Postcode*:

Email*:

Telephone (home):

Telephone (mobile):

 

Next of kin (to be contacted in case of an accident)

Name:

Telephone:

Address:

 

Entrant details (if applicable)

Entrant name:

Entrant licence no.:

 

Clubs and Licences

I am a member of:

Championships entered:

HSA member no.:

HSA Expiry date:

Competition licence type:

Competition licence no.:

Have you ever held a road traffic licence?:

Yes No

 

Details of car

Class*:

Please select a Class S1 : Standard Road-Going Series Production Cars up to 2000cc S2 : Junior Sprint A1 : Road-Going Series Production Cars up to 1400cc A2 : Road-Going Series Production Cars over 1400cc & up to 2000cc A2.1 : Road-Going Series Production Mazda MX5s up to 2000cc A3 : Road-Going Series Production Cars over 2000cc A4 : Road Cars Series Production 4-Wheel Drive, any capacity F1 : Ferrari cars entered in the The Pirelli Ferrari Hillclimb Championship U1 : Classic Road-Going Saloon and Sports Cars built up to 31.12.1975 B1 : Road-Going Specialist Production cars up to 1700cc B2 : Road-Going Specialist Production cars over 1700cc C1 : Modified Series Production Cars up to 1400cc C2 : Modified Series Production Cars over 1400cc & up to 2000cc C3 : Modified Series Production Cars over 2000cc D : Modified Specialist Production Cars U2 : Classic Modified Specialist Saloon and Sports Cars built up to 31.12.1975 F : Hillclimb Super Sports cars & Sports Libre Cars H : Racing Cars up to 600cc I : Racing Cars over 600cc & up to 1100cc J : Racing Cars over 1100cc & up to 1600cc J1 : Formula Ford 1600 Racing Cars manufactured before 1.1.1994 K : Racing Cars over 1600cc & up to 2000cc L : Racing Cars over 2000cc W : Classic Racing Cars and Sports Racing Cars built up to 31.12.1975

Make:

Model:

Cubic capacity:

Turbo/Supercharged:

Reg. number (roadgoing):

Is the car fitted with a camera?:

Yes No

Does the car have on-board starting?:

Yes No

if NO, please supply starting procedure:

 

Other details

My car is to be shared with:

Which driver to run first:

Have you competed at Curborough before?:

Yes No

 

  I confirm that I have read the declaration and agree to be bound by the Regulations.