2012 FIA Super 2000 World Rally Championship - Registration Form
FEDERATION INTERNATIONALE DE L'AUTOMOBILE
2012 FIA SUPER 2000 WORLD RALLY CHAMPIONSHIP
FOR DRIVERS
REGISTRATION FORM
THE APPLICANT (driver or team or ASN designated team)
Full name
Country and date of birth (If applicable)
Country of residence
Address
Tel
Mobile:
Team name and address
(If different from the above)
Tel
Team Manager (if applicable)
Tel
Mobile:
Authorised representative(s) Title
with sole power to bind the entrant Title
Title
DETAILS OF REGISTRATION
Entrant national competition issued by
Licence number
Entrant name
(As mentioned on the licence)
Driver(s)*
Licence number(s)* issued by
I undertake to participate in each of the 7 Nominated Rallies. In accordance with Article 8.2.3 of the 2012 FIA World Rally Championship Sporting Regulations, my 7 Nominated Rallies are:
1. 17-22 January Rally Monte-Carlo (MCO) c
2. 09-12 February Rally Sweden (SWE) c
3. 29 March – 01 Apr. Rallye de Portugal (PRT) c
4. 22-24 June Rally of New Zealand (NZL) c
5. 02-08 August Rally Finland (FIN) c
6. 13-16 September Rally of Great Britain (GBR) c
7. 04-07 October Rallye de France - Alsace (FRA) c
8. 01-04 November RallyRACC Catalunya-Costa Daurada (ESP) c
(Please tick the 7 relevant boxes corresponding to your 7 Nominated Rallies)
I confirm that I have read and understood the provisions of the International Sporting Code, the Technical Regulations applicable to the group of cars participating in the 2012 FIA World Rally Championship Cup, the 2012 FIA World Rally Championship Sporting Regulations. I agree to be bound by them (as supplemented or amended) and furthermore I agree on my own behalf and on behalf of everyone associated with my participation in the 2012 FIA World Rally Championship Cup to observe them. I declare that I have examined this Registration Form and that the information given is true, correct and complete.
FOR THE APPLICANT:
SIGNED BY (SIGNATURE)
(PRINT NAME OF THE PERSON SIGNING)
Being a person duly authorised
to sign for and on behalf of
(PRINT FULL NAME OF APPLICANT)
Date
* optional
Thank you to return this form, duly completed and signed, no later than 12 December 2011 to the following e-mail address:
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