Registration

Name (Driver) *

Nation *

Address *

Post Code *

Ciy *

Phone *

FAX

E-Mail *

Size *

Name (Co-Driver) *

Nation *

Address

Post Code

City

Phone

FAX

E-Mail

Size *

Entry fee for two persons € 1.390.-- incl. 20% VAT.

Brand *

Type *

Year of construction *

HP/KW *

CCM *

CYL *

Chassis Nr. *

Engine Nr. *

Vehicle history

Photo of car

Photo of car :: Das Foto darf die Größe von 400kb nicht übersteigen !

* I accept the mentioned participation and liability provisions. The entry fee will be transferred until the 18th February 2011.