Don't miss this year's Defi on September 10th and 11th 2010

REGISTRATION FORM

Event name : Rallye Défi 2010

Note : If your registration is not correctly filled, it will be refused, and will be effective only on entry fees reception

Championship: National National + OPRC OPRC CRQco
Date:
Seed:
National class: Expert Novice
Regional class: Expert Novice/Clubman

Entrant:
     Name:
     Phone:
     E-mail:
     Address:
     City:
     Province/State:
     Postal Code:

Driver:
     Name:
     Phone:
     E-mail:
     Address:
     City:
     Province/State:
     Postal Code:
     Driver's licence no.:
     Province/State:
     Compet. licence no.:
     CARS: National      Regional
     RA and NASA: National      Division

Co-driver:
     Name:
     Phone:
     E-mail:
     Address:
     City:
     Province/State:
     Postal Code:
     Co-driver's licence no.:
     Province/State:
     Compet. licence no.:
     CARS: National Regional
     RA and NASA: National Division

Vehicle:
     Class: Open Gr2 Gr5
     P-Sport P-GT
     Make:
     Model:
     Year:
     Colour:
     Engine displ.:
     No. of cylinder:
     Licence plate no.:
     Province/State:
     Insurance Co.:
     Policy no.:
     Sponsors:
     Car name to be used in pub.:

REQUIRED:
Email adress for confirmation:

Click here to access a printable version of the waiver, it has to be signed and returned to the organizing committee to valid this present form.