Registration

Competitors entry form - BIKE / QUAD

Please, fill-in and submit the entry form. Your entry becomes definitive upon reception of the full amount of entry fees due.

DRIVER/PILOT DATA

Family Name*

First Name*

Male/Female*

Date of Birth*

Nationality*

Driving Lic No*

Blood type*

Telephone No

Mobile No*

Fax No

E-mail*

Address*

City*

Zip/Post Code*

Country*

Emergency contact person*

Relationship*

Telephone No*

Competing in other rally raids

Team

Jersey size*

VEHICLE IN RACE

Class*

Start No

Make*

Model*

Year*

Engine cc*

Traction* МОТО2WD4WD

Registration No

Country of registration

Chassis No

Engine No

Owner

Insurance company

Contract No

Expiration date

GPS model*

ASSISTANCE CAR

Make

Model

Registration No

Trailer No

Assistant N1 (name)

Assistant N2 (name)

I, declare that to the best of my knowledge all the information provided above is correct. I understand that the demand is considering as an order form.
I understand that it is our unique responsibility to ensure that all the documents required to participate in the competition are valid, especially my driving licence, my vehicle ownership and insurance documents. I declare that we enter the competition in full knowledge of the risks such a race involves and renounce in advance all responsibility on the part of the organisers of the competition, penal or civil in case of bodily or material accident or death during the rally. I declare, I've read and approved the entry fee conditions and the regulation of the Rallye.

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Registration

Competitors entry form - BIKE / QUAD

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