ASEMC - Association of South Eastern Motor Clubs

ASEMC CLUB STAGE RALLY CHAMPIONSHIP 2009

REGISTRATION FORM

DRIVER CO-DRIVER

FIRST NAME

SURNAME

ADDRESS

POSTCODE

E-MAIL

HOME PHONE

MOBILE PHONE

DAYTIME PHONE

CLUB

CLASS

CAR MAKE

MODEL

ENGINE CC

COLOUR

REG. NO.

Please return form to:

Peter Baylis, 8 Jarrett Avenue, Wainscott, Rochester, Kent

with remittance of £10/£15

For ASEMC use

Rec'd date

Paid

Card(s) Issued

	DRIVER	CO-DRIVER
FIRST NAME
SURNAME
ADDRESS
POSTCODE
E-MAIL
HOME PHONE
MOBILE PHONE
DAYTIME PHONE

CLUB
CLASS
CAR MAKE
MODEL
ENGINE CC
COLOUR
REG. NO.

	Please return form to: Peter Baylis, 8 Jarrett Avenue, Wainscott, Rochester, Kent with remittance of £10/£15
For ASEMC use
Rec'd date
Paid
Card(s) Issued