Engagement 1er Européan Dragster EU

APPLICATION FOR COMMITMENT AUTOS - RACES ACCELERATIONS

Technical Mini Index *:
* Do not fill

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

Category

1er Européan Dragster
Le 6 & 7 Juin 2015

Reception date

Postmark

PILOT
Name
First Name
Adress
Country
Phone
E-MAIL
Driving license #
Issue date
I will take a license for the day the day of the race
YES
LICENSE INFORMATION
Number
ASA Code
ASA Name
Club/Team

Date of Birth
ZIP / City
Fax
Mobile
At
NO
Required medical certificate
Category

COMPETITOR
Name
Adress

First Name

Pseudonym
ZIP / City
Fax
Mobile

Phone
E-MAIL
LICENSE INFORMATION
ASA Code
Club/Team

Number
ASA Name

VEHICLE

Category

* MINI INDEX category (7.5s)

Vehicle name

Model

Brand

Displacement

Registration Plate #

Technical Passport #

Color

Ref Time 1/4 Mile

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

I pay by CHECK-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

APPLICATION FOR COMMITMENT AUTOS - RACES ACCELERATIONS

REGISTRATION FORM

er

1

Européan Dragster
6 & 7 Juin 2015

Information : Eric Angeloni : 06 73 58 58 36 Email: atd2003@free.fr
Christophe Dubois : 06 87 45 64 71 Email: Christophe.Dubois@AirLiquide.com
www.trophee-dragster.fr and www.francedrag.com
Registration : A.T.D. chez Mr Angeloni Eric 9 impasse pont Barraux

03270 Saint Yorre

1er Européan Dragster
Les 6 & 7 Juin 2015 – Circuit de Clastres (02)

125 €

Additional
Person
15 €

Total : _ _ _ _ _ €

Street Run A, B, C (2 Persons)
Pro ET (4 Persons)

125 €
125 €

15 €
15 €

Total : _ _ _ _ _ €
Total : _ _ _ _ _ €

Super Pro ET (4 Persons)
Junior Dragster (2 Persons)
not licensees ASA Drag Racing

125 €
Free
25 €

15 €
15 €

Total : _ _ _ _ _ €
Total : _ _ _ _ _ €
Total : _ _ _ _ _ €

For two days with track access

Prices

RWYB (2 Persons)

These prices are per vehicle per person for ASA Drag Racing licensees
If not licensees at ASA Drag Racing price is increased by 25 € (Not for RWYB)
REGISTRATION DEADLINE
26 May 2015
PAST THAT DATE AN ADDITIONAL 40€ WILL BE CHARGED