ITALIAN RALLYCROSS
CHAMPIONSHIP

OFFICIAL ENTRY FORM

EMAIL*
DIVISION*
COMPETITION NUMBER
COMPETITOR
Name*
First Last
Address*
Street Address City Province / Region ZIP / Postcode Country
Date of birth*
MM slash GG slash AAAA
Place of birth*
Mobile Phone*
Licence No*
Please upload a copy / photo of your competition Licence*
Trascina i file qui oppure
Dimensione max del file: 128 MB.
DRIVER
CONDUTTORE DIVERSO DAL CONCORRENTE
- IF DRIVER DIFFERENT TO THE COMPETITOR
Hidden
Name*
First Last
Address*
Street Address City Province / Region ZIP / Postcode Country
Date of birth*
MM slash GG slash AAAA
Place of birth*
Mobile Phone*
Licence No*
Please upload a copy / photo of your competition Licence*
Trascina i file qui oppure
Dimensione max del file: 128 MB.
CAR
Make / Model / Engine CC*
Technical Passport No
Transponder No
INVOICE
Scelta Invoice
- Invoice
Business name*
Address*
Street Address City Province / Region ZIP / Postcode Country
Phone*
Email*
VAT N°*
TICK THE RACE:
Calendario*
- RD#6 - 17-18 OCTOBER - ITTIRI (SS)
- RD#7 - 30-31 OCTOBER - MAGGIORA
DICHIARO CHE TUTTE LE INFORMAZIONI DATE SONO CORRETTE*
- I AGREE TO RXITALIA NEWSLETTER
- I CONFIRM THAT THE INFORMATION GIVEN ON THIS APPLICATION FORM AND ANY SUPPORTING DOCUMENTATION IS TRUE AND COMPLETE