ITALIAN RALLYCROSS
CHAMPIONSHIP

ENTRY FORM

EMAIL*
DIVISION*
RACE NUMBER
COMPETITOR
Name*
First Last
Address*
Street Address City Province / Region ZIP / Postal Code Country
Date of birth*
Formato data:MM slash GG slash AAAA
Place of birth*
Phone*
Licence N°*
Please upload a copy / photo of your competition Licence*
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DRIVER
CONDUTTORE DIVERSO DAL CONCORRENTE
- DRIVER DIFFERENT FROM THE COMPETITOR
Name*
First Last
Address*
Street Address City Province / Region ZIP / Postal Code Country
Date of birth*
Formato data:MM slash GG slash AAAA
Place of birth*
Phone*
Licence N°*
Please upload a copy / photo of your competition Licence*
Trascina i file qui oppure
CAR
Make / Model / CC*
Technical Passport N°
INVOICE
Scelta Invoice
- Invoice
Business name*
Address*
Street Address City Province / Region ZIP / Postal Code Country
Phone*
Email*
VAT N°*
TICK THE RACE:
Calendario*
- RD#3 - 17 OCTOBER - MAGGIORA REVERSE
- RD#4 - 18 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