Bitte füllen Sie alle mit * markierten Felder aus. (Pflichtfelder)

APPLICATION FORM “ROAD TO WACKERSDORF” (20/07 – 23/07/2023)

(Entry for single Event “ROAD TO WACKERSDORF 2023”)
CHOOSE YOUR CATEGORY:*

With this application form Entrant and Driver entrust and authorize the DMSB or DMSW GmbH to submit on their behalf entries to the promoter of the event “ROAD TO WACKERSDORF - RTW” of the selected above category of “RTW Event” (block entry). 

The complete application form must be personally signed by the Entrant as well as by the Driver (and possibly also by the legal representatives) latest during Sporting Check of the “RTW Event” or during the previous period of inscription procedure by sending it by post.

 

PLEASE COMPLETE ALL THE FIELDS BELOW

( * = for this marked field the completion is obligatory)

ENTRANT

Filling out the Entrant’s details is obligatory. The Entrant must be of legal age and holder of a valid international Entrant’s/Competitor’s licence.
Entrant`s name (consistent with licence):*
Entrant`s int. licence number:*
Type of licence (e.g. club, company, parent license):*
Issued by ASN:*

ENTRANT’S ADDRESS
Zip (postal code):*
City:*
Address (street/no.):*
Country:*
Mobile phone number:*
Email‐address:*

ENTRANT’S REPRESENTATIVE ON SITE
Name and given name of team representative / team chief:
Mobile phone number:
Email-address:

DRIVER
Last name:*
Given name:*
Gender:
Date of birth:*
Kalender

DRIVER’S ADDRESS
Zip (postal code):*
City:*
Address (street/no.):*
Country:*
Mobile phone number:*
Email‐address:
Driver`s licence‐no. (incl. letters):*
Grade of your int. kart licence:*
Issued by ASN:*
Start number request (There is no guarantee that you will receive this start number):

 

DMSB SPONSOR CARD (if available)
Sponsor`s name (consistent with licence):
DMSB sponsor card number:

KART
Chassis make:
Engine make:
TYRES   Slick tyres: LECONT SVC PRIME 10x4.50-5 (front) and SVC PRIME 11x7.10-5 (rear)
 Wet weather tyres:LECONT SV1 10x4.20-5 (front) and SV1 11x6.00-5 (rear)

OWNER OF THE COMPETITON EQUIPMENT

Please choose the valid situation:
The owner is:*
Owner’s name or company / of owner: 
Owner’s address (ZIP Code / City):
Owner’s address (street/No.):

In the case of false statements, Entrant and Driver release the group of persons specified in the disclaimer of the kart owner from all claims of the kart owner with regard
to damages in connection with the event (= untimed and timed practice, qualifying practice, warm‐up, tests, races, heats). This applies also for costs of the kart owner
incurred in reasonably asserting his legal rights.

PLEASE NOTE:

This application should be sent as soon as possible. Timely processing of the application can be guaranteed if the Promoter receives the application by 19th June, 2023.

The entry fee of EUR 600,- incl. VAT will be invoiced to you by DMSW GmbH. Only after receipt of the corresponding invoice (please also note the fields to be filled out below) is payment to be made by bank transfer according to the invoice details.

 

 

INVOICE RECIPIENT  

The invoice for the registration/entry fees is to be issued on the name of

(if necessary VAT-ID-No for invoices without German VAT)
Please select:*
Name or company/recepient:
Email-address:
ZIP Code / City:
Street / no.:
Country:
VAT-ID-No:

OTHER SUPPLEMENTAL DATA 
Any information via email should be sent to
Name:
Email-address:

DON’T FORGET THE FOLLOWING MANDATORY DECLARATIONS:

Your data will be stored for the purpose of the contract between you as a participant and the organizer for participation in the event. Please declare your consent below:

 

Click here to read the privacy statement

You can revoke your consent at any time by sending an email to the series organizer. The data cannot be stored without consent. 

Please note: Participation in the events of the series is not possible without your consent given here.

 

If you want to print out this online form, you must do this BEFORE submitting the data, since the form is empty again after the data has been transmitted.

 

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