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26.08 - 29.08.2010
Entry Form
Nr. Gara
Nr. Dossier
Entrant
Name
Address
City
ZIP Code
Entrant Type
please select...
Motocycle
Motorcycle European Baja Cup
Quad
Quad European Baja Cup
Single Car
Single Car FIA Baja Cup (T1)
Car
Car FIA Baja Cup (T1-T2)
Truck
Town
State
Nationality
Mobile Phone
Email
In case of an accident
Name
Telefon
1st Driver
Name
Surname
Address
Town
City
State
Mobile Phone
Email
Nationality
Place of Birth
Date of Birth
Blood Group
Licence Nr.
Driving Licence Nr.
Driving Licence Expire
Hotel
2st Driver
Name
Surname
Address
Town
City
State
Mobile Phone
Email
Nationality
Place of Birth
Date of Birth
Blood Group
Licence Nr.
Driving Licence Nr.
Driving Licence Expire
Hotel
3st Driver
Name
Surname
Address
Town
City
State
Mobile Phone
Email
Nationality
Place of Birth
Date of Birth
Blood Group
Licence Nr.
Driving Licence Nr.
Driving Licence Expire
Hotel
Team
Team
Licence Nr.
Vehicle
Manufacturer
Model
Group/Class
Drive
please select...
2WD
4WD
Capacity
Plate Nr.
Chassis Nr.
Fuel
please select...
petrol
diesel
Invoicing
Company Name
Address
City
ZIP Code
State
VAT Nr.
Privacy
We declare to be acquainted with the race’s regulations and to fully accept its terms. We clear the organizers from all responsibility in case of accident.
Signatures
Signature of Competitor
Signature of 1st Driver
Signature of 2st Driver
When filled send to:
When filled send to: Fax: +36 88 789 508 and please send us the confirmation of the bank transfer.
Bank
UNICREDIT Bank Hungary
GIRO:
10918001-00000047-68630000
IBAN:
HU16 1091 8001 0000 0047 6863 0000
BIC/SWIFT:
BACXHUHB
note: „Entry fee for HunGarian Baja (DRIVER’S NAME)”
Brava Foto 2010
Kollár Sport Foto 2010
2004-2009
2008
