RESERVED FOR ORGANIZATION NUMERO DI GARA PROTOCOLLO PERIODO CATEGORIA ENTRY FORM: * The fields marked with an asterisk * are obligatory Name & Surname Address Birth date * Birth place * DRIVER Zip Code - Town * Country Telephone Fax E-mail * Mobile * Driving Licenze * Expiring Date * Team S Fiscal Code (only needed for Italy) * Size M L XL XXL XXXL M L XL XXL XXXL * Town *Passport data * full passport data allow faster hotel registration Name & Surname Address Birth date * Birth place * CO-DRIVER Zip Code - Town * Country Telephone Fax E-mail Mobile * Driving * Licenze Expiring Date * Team Size * *Passport data Town * S * full passport data allow faster hotel registration INSURANCE CAR Make * Engine capacity Plate * Year * Company Number * Fiche F.I.A. Heritage A.S.I. * Model * * * F.I.V.A. Identity * Card Expiring Date HISTORIC INFO OF THE CAR * ENTRY FEE * (for 2 drivers in double room) For any accommodation other than those listed, contact the Organization: [email protected] 3 days - complete package Including Friday dinner 2 days – 1 night Including Friday dinner 2 days – 1 night - Friday 3 days - no overnight Including Friday dinner dinner not included Euro 745,00 Euro 680,00 Euro 585,00 Euro 540,00 Includes: sport entry fee Two nights (Friday & Saturday) Friday dinner Includes: sport entry fee One night (Saturday) Friday dinner Includes: sport entry fee One night (Saturday) Includes: sport entry fee Friday dinner Saturday Lunch and Dinner Saturday Lunch & Dinner Saturday Lunch & Dinner Saturday Lunch & Dinner Sunday Lunch Sunday Lunch Sunday Lunch Sunday Lunch 2 days - no overnight Friday dinner not included Euro 445,00 Includes: sport entry fee Saturday Lunch & Dinner Sunday Lunch Participation in “La Corsa di Alcide” is reserved for cars built until the year 1982. The Organization reserves the possibility to admit particular aesthetic and technical cars, built in the years immediately following, with separate classes. Will be allowed to race a maximun of 100 cars. In the case of applications for enrollment in excess of the organizer will make a selection on the basis of the following preferences criteria: year of construction, rarity of the model, type “barchetta”, particular aesthetic and technical model. The Entry Form must be completed in its entirety and accompanied by copy of Bank Money Order in the name of: ASSOCIAZIONE ALTITUDE EVENTI - “CHIANTI BANCA”, IBAN IT24B0867371940003003032462 SWIFT/BIC ICRAIT3FIP0. If the entry will not be accepted the sum will be refunded by bank transfer within 60 days from the closing of entries. It ‘expected the night guard of the car. GENERAL DISPOSITIONS By registering, each participant declares for himself, his passengers and his representatives, to be aware and accepts the various rules of the event and also declares to renounce referring to a lawyer or judge for any reason deriving from the organization and during the course of the event, furthermore, declares the non-responsibility of organizing companies, sponsors of the event, the A.S.I., as well as the owners and managers of the roads travelled on, the company “Altitude Eventi” and all the people involved in the organization, from any responsibility or damage occurred during converging events, his directors, his passenger, his dependents, his belongings, or produced or caused to third parties belongings of third parties, from the participant. All the refers also to situations not mentioned but connected to the event. Send this form by mail no later than 14 May, 2012 to: ASSOCIAZIONE ALTITUDE EVENTI - VIA G.GARIBALDI, 37 - 53036 POGGIBONSI (SI) - ITALY Email: [email protected] You can anticipate the entry form by e-mail, but it is obligatory to send the original entry form complete with the signature. DATE * CAR PHOTO (Please submit with the entry form or via e-mail) THE PARTECIPANT * INFORMATION REPORTING to Art.13 Your personal data will be processed manually by computer for purposes of: a) send information on cultural, scientific and recreational event; b) marketing, promotional and informative material (treatment that require your consent). For operations of mailing data may be shared with external companies responsible for organizing the event. The data will not be disclosed. Finally we remind you to exercise your rights under art. 7 of Legislative Decree 30 june 2003, no. 196, please contact the owner of, by writing to: ALTITUDE EVENTI - Via G.Garibaldi,37 - 53036 Poggibonsi (SI) - Italy. CONSENT (pursuant to article 13 of the Code of Personal Data) I consent to the processing of data for the purposes referred to in point a) I consent to the processing of data for the communications referred to in point b) DATE * THE PARTECIPANT In the case of failure to partecipate in the competition La Corsa di Alcide, the company organizing Altitude Eventi, reserves the right to retain a penalty equal to 50% of the amount paid to cover the cost of reservations. In case of cancellation of the crew before the date of 14/05/2012 the penalty will not apply.