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.