ASEMC SPEED CHAMPIONSHIP 2011

Sponsored by

Essex Emergency Services 2000 Ltd

www.essexemergency2000.co.uk

Email:sales@essexemergency2000.co.uk

Championship Registration Form – Fee £10.00

I wish to register for and participate in the 2011 ASEMC Speed Championship in the following vehicle:

Driver

 

Name………………………………………………………………………………………………………………………………………………..

Address………………………………………………………………………………………………………….………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….Post Code………………………………

Email Address:…………………………………………………………………………………………………..

Telephone Number:…………………………………………………………………………………………..

Mobile:………………………………………………………………………………………………………………

 

ASEMC Member Club…………………………………………………………………………………………

Are you eligible for the Masters Trophy? Over 50?...............................................

 

Vehicle

I wish to compete in Category…………………………………………Class…………………………

Make………………………………………….Model………………………………………….CC……………

 

Signed………………………………………………………….Date…………………………………………..

Please complete this form and return it with a cheque for £10.00 made payable to ‘The ASEMC’ and forward to: Chris Judge  66,Olivers Mill, New Ash Green, Longfield, Kent DA3 8RF.