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Комитет по физической культуре, спорту и туризму Мурманской области


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4x4 Raid

 

APPLICATION FORM

Download application form

 Car model
 Petrol consumption in off-road condition  liters per 100 km
 Fuel type
 Reg. car number

 First driverSecond driverParticipant
 Surname
 Name
  Date of birth
 Nationality
 Passport (№)
  Date of issue
 Gender
 Blood group
 Post address
 Home tel/fax
 Work tel/fax
 E-mail:
 Profession
 Participation of similar competitions

In case of accident should address to
 Surname
 Name
 Post adress
 Telephone

We state our participation in "Arctic Trophy 2010" and are informed about all risks we take. We as well do not claim to the organizers of "Arctic Trophy 2010" on any material or physical damage, which can be caused during competition. We confirm that we get acquainted with the competition rules and conditions and agree with them without any limitations.

Before signature write: "Acquainted and agree"

Date: Signature:
Date: Signature:
Date: Signature:

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Any questions? Feel free to contact us at info@at4x4.ru or call by number +7 921 725 7757

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