Registration | e-miglia 2012

The registration for the e-miglia 2012 will start on March 1^st ,2012 and is only possible with the registration form posted here. This has to be completed online, then printed out via the print function (at the end of the page) and mailed to the organization office of the e-miglia 2012. A delivery via e-mail or fax is not permitted. The registration will end on June 15th, 2012.

Please note: A registration is admissible for individual drivers, as well as for teams with two people in a vehicle. The incidental participation fee has to be paid for each person. The registration is only considered completed if the registration form has been mailed and the entry fee has been paid. The registration is secured if you have received an official nominal confirmation from the organizer in the mail.

You can find additional information regarding the registration and the services involved in the Regulations.

Applicant (applying person/company)

Company:

Last name*:

First name*:

Street/House no.:*:

ZIP code / City*:

Phone*:

Mobile*:

E-mail*:

Team name*

Driver

Last name*:

First name*:

Street/House no.:*:

ZIP code / City*:

Nationalität*:

Phone*:

Mobile*:

E-mail*:

Co-driver

Last name:

First name:

Street/House no.:

ZIP code / City:

Nationality:

Phone:

Mobile:

E-mail:

Vehicle

Evaluation category*:
Category 1: Purely electrically powered two-wheeler
Category 2: Purely electrically powered three-wheeler
Category 3: Purely electrically powered four-wheeler

Manufacturer*:

Model*:

License plate*:

Vehicle owner*:

Please send the nominal confirmation *
to the driver
to the co-driver
to the applicant

Will you be accompanied by service vehicles?*
No
Yes
Number of service vehicles:

Service /accompanying person

Last name:

First name:

Street/House no.:

ZIP code / City:

Mobile:

Last name:

First name:

Street/House no.:

ZIP code / City:

Mobile:

Last name:

First name:

Straße:

PLZ / Wohnort:

Mobil:

Last name:

First name:

Street/House no.:

ZIP code / City:

Mobile:

Participation fee

Per person (driver, co-driver)*
Per service vehicle
Per service person/accompanying person

1.500,00 €   x
200,00 €   x
400,00 €   x

Gesamtbetrag

The participation fee was transferred to the bank account of Offroad Solutions Ltd.
Allgäuer Volksbank Sonthofen, Kto: 595 020, BLZ 733 900 00
IBAN: DE 08 7339 0000 0000 5950 20 BIC, SWIFT: GENODEF1KEV

The participation fee is included in form of a voucher check.

Please send the invoice for the participation fee to the following address:
Applicant
Driver
Co-driver

I have read and agree to the e-miglia 2012 General Terms and Conditions and the Regulations.

I have also read and and agree to the Waiver of Liability and to the Assignment of privacy rights. I have signed both and am including them with the application.

I agree to the publication of my name and my rally results.