Please check box to confirm photo sent to chris@challengesouthwest.co.uk

Please check box to confirm acceptance of the rules and regulations

Vehicle Specifications and Modifications (check box for yes)

Driver's full name

Crew full name

Driver's full address (inc postcode)

Crew's full address (inc postcode)

Contact Telephone

Contact Mobile Phone

Contact e-mail address

Next of kin (driver) - name & phone no please

Next of kin (crew) - name & phone no please

Vehicle make and model

Vehicle Registration number

Front Winch

Rear Winch

Front Lockers

Centre Winch

Rear Lockers

Portal Axles

Other modifications (please describe)

Tyre Type and Size

Please indicate driver age range

Any health issues/disabilities? (will remain confidential)

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Please give reasons why you cannot camp (will remain confidential)

Please provide a current (digital format) picture of your vehicle for publishing to the event web site.

I have read the rules and regulations for this event and certify that my vehicle complies with the regulations as published by Challenge South West.