Registration

Competitors entry form - CARS & BUGGY

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

DRIVER/PILOT N1
Family Name*
First Name*
Male/Female*
Date of Birth*
Nationality*
Driving Lic No*
Blood type*
License No
Mobile No*
Medical Insurance*
E-mail*
Address*
City*
Zip/Post Code*
Country*
Emergency contact person*
Relationship*
Telephone No*
Т-shirt size*
DRIVER/PILOT N2
Family Name
First Name
Male/Female
Date of Birth
Nationality
Driving Lic No*
Blood type
License No
Mobile No*
Medical Insurance*
Email
Address
City
Zip/Post Code
Country
Emergency contact person
Relationship
Telephone No
Т-shirt size
ТЕАМ
Club name
VEHICLE IN RACE
Class*
Make*
Model*
Year*
Engine cc*
Traction*
Registration No
Country of registration
Chassis No
Engine No
Owner*
Insurance company
Contract No
Expiration date
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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