Post on 24-Aug-2020
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GRUPPOPERONIRACE
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IMOLA 12 - 13 Ottobre 2019 Please send to/ Inviare a: GRUPPO PERONI RACE Srl Via Prati della Farnesina, 57 00135 - Roma – Italy a.casseri@gruppoperoni.it Fax: +39 06 45441336
ENTRANT DETAILS Entrant/Concorrente
Address/Indirizzo
Town/Città Postal Code/CAP
Phone number/Tel Fax
Entrant Licence No./Licenza N.
VAT No/Partita IVA
Mail ing address if different/Indir izzo per la corrispondeza se diverso
Address/Indirizzo
Town/Città Postal Code/Cap
Phone number/Tel Fax
Entry fee: CHAMPIONSHIP 500€ a vettura/car
GOLD 2.000,00 Euro plus VAT
BRONZE 2.000,00 Euro plus VAT
SILVER CUP 2.000,00 Euro plus VAT Banca Popolare Commercio e Industria IT 11 J 03111 03217 000000 096035
Deadline for inscriptions/Termine iscrizioni : 4 October 2019 – 4 Ottobre 2019
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1st Driver 2nd Driver
Surname/Cognome
Name/Nome
Address/Indirizzo
Town/Città
Postal Code/CAP
Date of birth/Data di nascita
Nationality/Nazionalità
Phone number/Tel
Fax
Mobile Phone/Cellulare
Licence No./Licenza N.
3rd Driver Reserve Surname/Cognome
Name/Nome
Address/Indirizzo
Town/Città
Postal Code/CAP
Date of birth/Data di nascita
Nationality/Nazionalità
Phone number/Tel
Fax
Mobile Phone/Cellulare
Licence No./Licenza N.
GRUPPOPERONIRACE
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CAR DETAILS/DETTAGLI VETTURA
Make/Costruttore Type/Modello Year of manufacture/ Anno di costruzione Cubic Capacity/
Cilindrata
No. of Electronic Passport / Numero passaporto elettronico
Weight/Peso
Fuel type/ Alimentazione
Benzina Diesel Turbocharged/Turbo
Yes No
Class/Classe
Car is equipped with FIA fast refuelling system/ La vettura è dotata si sistema di rifornimento FIA
Yes No
In signing the above entry form I, the Competitor, agree to the information and accept treatment of all communication including our Company details Please sign and stamp in the relevant space below
Entrant/Concorrente
1st Driver
2nd Driver
3rd Driver
Reserve
• To formally confirm that he/she has read and understood the ACI provisions governing the Italian Sportive activity and the International Sporting Code. He/she also declares to have read and understood the Sporting and Technical Regulations and expressly declares to accept them entirely. The Competitor agrees to be bound by them (as supplemented or amended) and furthermore agrees to observe on his/her own behalf and on behalf of everyone associated with his/her participation. • The Competitor hereby declares to indemnify and hold harmless the ACI, GRUPPO PERONI RACE, the Organizers, the Stewarts and all persons directly or indirectly involved in the organization and promotion of the races from any responsibility for damage or loss of whatever nature may arise out to the Competitor and to any other person connected in any way to the Competitor itself (Drivers, Employees, Consultants, Guests etc.) from the participation. • To unconditionally approve the Sporting and Technical Regulations of races in compliance to the articles1341 and 1342 of Italian Civic Code. • Furthermore he/she declares to commit himself/herself to have his/her Driver use the fireproof clothes and the helmet homologated according to the FIA regulation thus indemnifying the Organisers, the Stewarts and the ACI from any responsibility may arise in default of non-observance of the present commitment.
GRUPPOPERONIRACE
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SERVICE VEHICLES AND PIT ALLOCATION / MEZZI ASSISTENZA E SPAZIO PADDOCK
Entrant/Concorrente
Team Manager:
Phone / Mobile: A dedicated area with water and electricity connections will be allocated in the paddock to each entrant
Transport company/Compagnia Trasporto
Type of service vehicle/Tipo veicolo assistenza
Length/Lunghezza Width/Larghezza Box will be assigned to teams taking part to the event that have timingly applied. Garages will be assigned by the Organiser up to two different teams. Outside each it is forbidden to park any Camper or Caravan. If the box will be shared with another Team, only one truck each Team could be parked in front of the box. Box fares will be communicated by the Organiser or Circuit Management track bureau once its allocation has been confirmed. SERVICE VEHICLES/VEICOLI ASSISTENZA Please draw service vehicles layout.Disegnare l’ingombro del veicolo assistenza 0,5 mts (scale)