Entry form

Start No

Rider

Firstname

Lastname

Street address

Zip Code

Town

Nationality

Phone

E-mail address

Licence No One event licence

Date of birth

Club

Team name

Passenger / 2nd rider

Firstname

Lastname

Street address

Zip Code

Town

Nationality

Phone

E-mail address

Licence No One event licence

Date of birth

Club

Team name

Vehicle

Transponder no.

Mark

Model

Class

cc

Bore

Stroke

National sponsor licence

ID / Team

Licence number

I have read the Supplementary Regulations and schedule issued for this meeting and agree to be bound by them and by the ISC of the FIM, UEM and SML. I release the organizer of the competition and the said organizations from all liability in the event of any accidents.