Entry Form

ENTRY FORM

ACR - ROMANIA RALLY - MOL B-dul Unirii 11/A, 4800 Baia Mare, Romania
Fax : +40 62 221982

FORMULAR DE INSCRIERE
ENTRY FORM

Termen limita / Closing date 18.06.1998 ( 24.00 )

CONCURENT ENTRANT

Numele si prenumele

Name and surname

Adresa completa

Full address

Localitate Code

City Zip code

Telefon Fax

Phone Fax

PILOT 1^ST DRIVER

Numele si prenumele

Name and surname

Adresa completa

Full address

Localitate Code

City Zip code

Telefon Fax

Phone Fax

COPILOT 2^ND DRIVER

Numele si prenumele

Name and surname

Adresa completa

Full address

Localitate Code

City Zip code

Telefon Fax

Phone Fax

Informatii despre pilot Prioritar FIA.......... Prioritar ASN...................

Information about driver FIA prioriry.......... NSA priority...................

MASINA CAR

Marca Tip

Make Type

Capacitate Nr.de omologare

Capacity Homologation No.

Grupa Clasa

Group Class

Nr. sasiu/caroserie Nr.motor

Chasid/Body No. Engine No

Prin prezenta declar ca sunt constient de riscul si pericolul implicat de participarea la raliu.Imi asum deplina responsabilitate fata de inscrierea in raliu si nu voi depune nici un soi de plangere la adresa organizatorilor.Declar de asemenea ca cunosc Regulamentul Sportiv FIA precum si Regulamentul Sportiv National.Voi respecta intru totul aceste reguli, fara nici o exceptie.Ma oblig sa ma supun regulamentului raliului precum si instructiunilor si dispozitiilor Comitetului de Organizare.

Hereby I declare that I am aware of the risk and danger of participating in the rally. I take full responsibility of entering the event and I will not set any claims up to the organisers. I also declare that I know FIA Sporting Regulations and National Sporting Regulations. I ensure to respect all those rules with no exception .I take upon myself to make obedience to the rally regulations and Steward of the Meeting’s instructions and decisions.

Data:
Date:


Stampila solicitantului Entrant stamp	Stampila ASN ASN stamp

Semnaturi:
Signatures :

........................... ..................................... ..................................................

Solicitant Pilot Copilot

Entrant 1^st Driver 2^nd Driver