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REGISTRATION FORM

First Name:

 

 

Surname:

 

 

Date of Birth:

 

 

Nationality:

 

 

Passport number:

 

 

Passport exp. date:

 

 

Driving licence number:

 

 

Mobile phone number:

 

 

E-mail:

 

 

Blood Type:

 

 

 

DRIVER

CO-DRIVER

Emergency person:

 

 

Telephone number:

 

 

 

EMERGENCY

RACING VEHICLE

 

Vehicle holder:

 

 

Brand:

 

 

Model:

 

 

Engine (cc):

 

 

Plate number:

 

 

VIN number:

 

 

Insurance exp.date:

ASSISTANCE

fill in ONLY if you have an assistance. Each racing team is allowed to have ONE assistance vehicle! If you don't have assistance, please continue to submit your registration by clicking the "register" button below.

First Name:

 

 

Surname:

 

 

Date of Birth:

 

 

Nationality:

 

 

Passport number:

 

 

Passport expiration date:

 

 

Driving licence number:

 

 

Mobile phone number:

 

 

E-mail:

 

 

Blood Type:

 

 

 

Type of assistance:

DRIVER / HEAD ASSISTANCE

Emergency person:

 

 

Telephone number:

 

 

 

Vehicle holder:

 

 

Brand:

 

 

Model:

 

 

Engine (cc):

 

 

Plate number:

 

 

VIN number:

 

 

Insurance exp.date:

EMERGENCY

VEHICLE

Team name

format: D/M/YYYY

format: D/M/YYYY

format: D/M/YYYY

format: D/M/YYYY

format: D/M/YYYY

format: D/M/YYYY

format: D/M/YYYY

format: D/M/YYYY

use extension, e.g +420 for Czech Republic

use extension, e.g +420 for Czech Republic

use extension, e.g +420 for Czech Republic

use extension, e.g +420 for Czech Republic

for example: 2000 or 3500 etc.

for example: 2000 or 3500 etc.

use extension, e.g +420 for Czech Republic

this email will be used as a main contact email address

I am interested in transportation of my vehicle from Prague to Georgia:

more information on transportation can be found in important informations section, point 17