Syrian Rally Entry Form

‫ﻧﺎدي اﻟﺴﻴﺎرات اﻟﺴﻮري‬ Syrian Automobile Club

11-13 June 2009 INDIVIDUAL ENTRY FORM ENTRANT

FIRST DRIVER

CO-DRIVER

Team Name Family Name First(given) Name Date of birth Nationality (as passport) Postal address Passport Number Address for correspondence(1,2 or 3) Telephone No. (business) Telephone No. (private) Mobile Tel. No. Fax No. E-mail address Competition license No. Issuing ASN Driving license No. Country of issue

1.

3.

DETAILS OF THE CAR Registration No. C.C. Body No. Engine No. Predominant color Tech. Passport No.

Make Model Year of manufacture Group / Class Homologation No. Country of registration Type of entry

2.

Trade/Legal etc, Private/Amateur

Organizer’s proposed advertising accepted: Yes

No

Entry Fees (For this entry form to be valid it must be accompanied by the appropriate entry fees .A receipt for the full amount with optional advertising proposed by organizers paid to the entrants ASN , a bankers drafts or details of bank transfer etc..)

Entry Fees WITH the optional advertising proposed by the organizers ENTRY/FEES PRIVATE/AMATEUR OTHERS CLOSING DATE Reduced rate 500$ 1000$ 24:00hrs on 9 may 2009 Normal rate 900$ 1800$ 24:00hrs on 25 may 2009 Entry Fees WITHOUT the optional advertising proposed by the organizers Entry/FEES PRIVATE/AMATEUR OTHERS CLOSING DATE Reduced rate 800$ 1600$ 24:00hrs on 9 may 2009 Normal rate 1400$ 2800$ 24:00hrs on 25 may 2009

SEEDING INFORMATION First driver…………………… FIA priority A FIA priority B National seed National championship Winner? Event

YES/NO YES/NO YES/NO YES/NO Car

Group class…………

previous FIA seed if yes, year priority

YES/NO ………. ……….

if yes, championship………… Group

year…….

O/A Class position position

No. of finishers

Other

National

International

year

car…………………………..

DECLARITION OF INDEMNITY I have read and understood the regulation issued for this event and agree to be bound by them and by the international sporting code the FIA. In consideration of the acceptance of my entry or of my being permitted to take part in this event , I agree to save harmless and keep indemnified , the Syrian Automobile Club and all sponsors together with such persons who are responsible for the organization of the event and the receptive officials , servants , representative , employees and agents from all against actions , claims, costs expenses , and demands in respect of injury or death to my self , or any of may team members , and/or loss damage to my property howsoever caused arising out of or in connection with my entry or taking part in this event , notwithstanding that the same may have been contributed to or occasioned by the negligence of the said bodies their officials , employees , servants , representatives or agents . ACKNOWLEDGEMENT AND AGREEMENT: By my signature I declare that all the information contained on the entry form is correct and that I acknowledge and agree in full to the terms and conditions of the above indemnity and that I accept all the terms and conditions relating to my participation in this event and I accept all the terms and conditions mentioned in the supplementary regulations. ASN Stamp*

Signature of Entrant

Signature of 1st Driver

Or letter from the entrant’s ASN authorizing and approving the entry Date………………………………

Signature of co-driver