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*

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: 256 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*

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: 256 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#3 - 20-21 MAY - MAGGIORA REVERSE (NO)

RD#4 - 16-17 JULY - CASTELLETTO DI BRANDUZZO (PV) (FIA CEZ)

RD#5 - 03-04 SEPTEMBER - ITTIRI (SS)

RD#6 - 22-23 OCTOBER - MAGGIORA (NO) (FIA CEZ)

CONFERME*

I AGREE TO RXITALIA NEWSLETTER

I CONFIRM THAT THE INFORMATION GIVEN ON THIS APPLICATION FORM AND ANY SUPPORTING DOCUMENTATION IS TRUE AND COMPLETE

ITALIAN RALLYCROSSCHAMPIONSHIP

OFFICIAL ENTRY FORM

COMPETITOR

DRIVER

CAR

INVOICE

TICK THE RACE:

ITALIAN RALLYCROSS
CHAMPIONSHIP