Driver Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Co-Driver Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Class

Tick to indicate which class you are entering

Class A - 2WD - 0-1300cc

Class B - 2WD - 1301-1600cc

Class C - 2WD - 1601-2000cc

Class D - 2WD - 2001cc and over

Class E - 2WD - Classic

Class F - 4WD - 1601-1999cc (AP4, R5 & Rally2)

Class G - 4WD - 2000cc and over

Class H - Subaru H6

Class I - Pre-96 4WD

Awards

Tick to indicate eligibility for other awards

Masters Driver

Masters Co-Driver

Rookie Driver

Rookie Co-Driver

''Non-resident" Driver

"Non-resident" Co-Driver

"Blind" Competitors (No use of notes)

Payment *

FEE TO REGISTER FOR 2024 SERIES: Driver $80.00 Co-Driver $80.00 Payable via Internet Banking to: Account Name: North Island Rally Series Account Number: 03-1528-0213498-000 Reference: [Driver Surname/Co-driver Surname]

Payment Sent

Consent *

By ticking this box I consent to the collection of the details on this registration form by the NIRS coordinator for event registration and promotional purposes and for them to retain, use and disclose these details to Motorsport NZ. I acknowledge my right to access and correct this information. This consent is given in accordance with the Privacy Act 1993.

I consent