Engagement 1er Européan Dragster EU

APPLICATION FOR COMMITMENT AUTOS - RACES ACCELERATIONS

Technical Mini Index *:
* Do not fill

Course number *:
* Please fill in if already raced in 2014 and
2015

Category

1er Européan Dragster
Le 6 & 7 Juin 2015

Received date

Postmark

PILOT
Name
First Name
Adress
Country
Phone
E-MAIL
N°driving license
Issued on
I will take a license from the day the day of the race
YES
LICENSE INFORMATION
Number
Code asa
Name ASA
Club/Team

Date of Birth
ZIP / City
Fax
Mobile
To
NO
Think of the medical certificate
Category

COMPETITOR
Name
Adress

First Name

Pseudonym
ZIP / City
Fax
Mobile

Phone
E-MAIL
LICENSE INFORMATION
Code ASA
Club/Team

Number
Name ASA

VEHICLE ENGAGE

Category

* MINI INDEX category (7.5s)

Vehicle name

Model

Brand

Displacement

Registration

N° Technical Passport

Color

Ref Time 1/4 Mile

** Price of commitment 125€ (ASA Drag Racing) or 150 € (other ASA) + extra bracelets. (5 maximum) ............... .x 10 € bracelets + 15 € x = ............
** price with optional advertising for any commitment received before May 26 (after. 165€ or 190 €)

I pay by CHEQUE-CCP
N°…………….………………………... payable to ATD

Bank

I certify exact the information on this application for commitment, do not be under a removal license or driver's license. I undertake to observe the technical
and sporting regulations of the event in accordance with specific regulations and the FFSA regulations, have to comply with the instructions of officials, and
not to resort to doping as defined by the International Olympic Committee, and accept possible controls doctors. . I accept that any damage or deterioration
caused by my team or my vehicle be immediately charged me.

Done at:
Signature
COMPETITOR

Signature
PILOT

VISA TROPHY

the:
ADMINISTRATIVE
VISA

VISA
TECHNICAL