Entryform Zuiderzeerally 2018
Entrant
First and Last Name *
Your answer
Adress *
Your answer
Postal code *
Your answer
City *
Your answer
Country *
Your answer
Nationality *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Phone number
Your answer
E-mailadress *
Your answer
Competitor license number *
Your answer
Driver
First and Last Name *
Your answer
Adress *
Your answer
Postal code *
Your answer
City *
Your answer
Country *
Your answer
Nationality *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Phone number *
Your answer
E-mailadress *
Your answer
Competitor license number *
Your answer
Type of competitor license *
Co-driver
First and Last Name *
Your answer
Adress *
Your answer
Postal code *
Your answer
City *
Your answer
Country *
Your answer
Nationality *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Phone number *
Your answer
E-mailadress *
Your answer
Competitor license number *
Your answer
Type of competitor license *
Details of the car
Make *
Your answer
Type *
Your answer
Year of manufacture *
Your answer
Class *
Group *
Your answer
2WD or 4WD? *
Registration number *
Your answer
Homologation number *
Your answer
Fuel *
Required
Entry
Championship *
Required
Do you agree with sending your contact details to other organizers of the FIA Benelux Rally Trophy? *
By sending this entryform we declare:
- That all information on this entryform is correct.
- That the use of the vehicle hereby entered will be covered by insurance as required by the law which is valid for such part of the event that shall take part on public roads.
- That we acknowledge and agree in full terms and conditions mentioned in the Supplementary Regulations and that we shall follow them strictly.
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