Registration | e-miglia 2012

Bewerber (anmeldende Person/Firma)
Company:

Surname:

Firstname:

Street:

ZIP code and city:

Phone:

Mobile:

E-mail:

Teamname:

Driver
(every field is mandatory)

Surname:

First name:

Street/house no.:

Zip code/city:

Nationality:

Phone:

Mobile:

E-mail:

Vehicle class/category
(please check applicable)

Class:
Class 1: Double-wheeled vehicle with electric motor
Class 2: Triple-wheeled vehicle with electric motor
Class 3: Four-wheel vehicle with electric motor

Co-driver

Surname:

First name:

Street/house no.:

Zip code/city:

Phone:

Mobile:

E-mail:

Team
(mandatory)

Team name:

Vehicle
(those fields marked with * are mandatory)

Manufacturer*:

Model*:

License-plate number *:

Vehicle owner*:

Service vehicle

Data 1. person
Surname:

First name:

Street/house no.:

Zip code/city:

Phone:

Mobile:

Data 2. person

I have read and accepted the e-miglia 2011 regulations, the general terms and conditions, as well as the waiver of liability and am enclosing them signed with the registration.

I request an official invoice for the participation fee from the organizer. Please issue and send the invoice to the following address: