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Registration Request

Please note...
if you have entered events run by the HISTORIC RACING CLUB Inc in the last few years
there is a high probability that you are already setup in the database.
If this is likely please use the Enquiry Form on the ContactUs Page and we will send you your UserName and Password.

 

Personal Details
Username*
First Name*
Last Name*
Password*
 
Organisation Details
(Where Entrant is an Organisation)
Name
 
Competition Licence
Date of Birth (Drivers only) (or blank for NA "Not Applicable")
License Nbr* (or TBA "To Be Arranged")
License Expiry Date* (or blank for TBA)
(or use TBA)
     
 
Postal Address
Address 1*
Address 2
Address 3
City*
Post Code
 
Residential Address (if different)
Address 1
Address 2
Address 3
City
Post Code
 
Contact
Email*
Home Phone
Business Phone
Mobile Phone
Fax Phone
 
Emergency Contact
Name*
Relationship*
Phone*
 
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