ENTRY FORM
THE INTERNATIONAL ROUND KURLAND
HISTORIC MOTORCYCLE RALLY
TEAM : 14th-16th July, 2006.
Rider -- T-shirt size M/ L/ XL/ XXL Passenger – T-shirt size M/ L/ XL/ XXL
Name (Mr, Mrs, Miss) Name (Mr, Mrs, Miss)
Surname Surname
Address Address
Address Address
Country Country
Phone/Fax #/ e-mail Phone/Fax #/ e-mail
Birth date Birth date
Club represented Club represented
Vehicle I wish to take part in Timed/Untimed Road Run. (Please underline which!)
Motorcyle/
Cycle car Make Model Year
Reg. #
Capacity # of cylinders Engine type Cruising Speed
Any interesting details about rider/passenger or machine – please write on a separate sheet!
Accompanying Vehicle: Reg. #
INDEMNIFICATION.
I wish to take part in the INTERNATIONAL ROUND KURLAND HISTORIC MOTORCYCLE RALLY. I have read the Rally Regulations issued for this event and agree to be bound by them. I understand that I am taking part in this event at my own risk. In consideration of the acceptance of my entry, I agree to save harmless and keep indemnified the Vintage Motorcycle Section (SMS) of the Antique Automobile Club of Latvia (AAK), RAMOTO Ltd. and the owners of any land and real estate used for the event and their respective officials, servants, representatives and agents from and against all actions, claims, costs, expenses and demands in respect of death or injury to myself or damage to my vehicle, however caused arising out of, or in connection with, my entry or taking part in this meeting.
Signature: ___________________________
Entry Fees* = number of people in the group _____
Entry Fee for Rider is Euro 100 (approax. LVL 70), for Passenger Euro 90 (approax. LVL 56). Entry Fees include participation in a 3-day event: coupons to all planned meals, tickets to Welcome Dinner & Dinner and Dance on 14th and 15 th July, guarded vehicle parking, souvenir prize. A filled-in Entry Form with credit card details** must be accompanied by 2 photographs of the machine (from each side) and sent direct to the Rally Organizer Juris Ramba, Lapu # 10, Ogre LV 5001, LATVIA,
e-mail:
[email protected]
to arrive on or before June 14th, 2006. Entry Fees, in the event of non-attendance, shall be refunded 100%, less 15% Administration Fee – subject to a written application. For Accommodation Fees please see separate Accommodation Requirements sheet.
Total Entry Fees in Euros: _____________
Credit card details: VISA, EUROCARD/ MASTERCARD. (Please underline which.)
Name ____________________ Surname ________________________
Card #
CVC or CVV Code ___ ___ ___ (last 3 digits in printed number on the reverse of the card)
Expiry date: ______________ Signature: ____________________
** We can also accept bank-to-bank money transfers. Please ask for details. No cheques please! No payment on the day!